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Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography.
J Bone Joint Surg Am. 2017 Sep 20; 99(18):e98.JB

Abstract

BACKGROUND

The 3-dimensional nature of adult acquired flatfoot deformity can be challenging to characterize using radiographs. We tested the hypothesis that measurements on weight-bearing (WB) cone-beam computed tomography (CT) images were more useful for demonstrating the severity of the deformity than non-weight-bearing (NWB) measurements.

METHODS

We prospectively enrolled 12 men and 8 women (mean age, 52 years; range, 20 to 88 years) with flexible adult acquired flatfoot deformity. The subjects underwent cone-beam CT while standing (WB) and seated (NWB), and images were assessed in the sagittal, coronal, and axial planes by 3 independent observers who performed multiple measurements. Intraobserver and interobserver reliabilities were assessed with the Pearson or Spearman correlation and the intraclass correlation coefficient (ICC), respectively. Measurements were compared using paired Student t tests or Wilcoxon rank-sum tests. P < 0.05 was considered significant.

RESULTS

We found that overall the measurements had substantial intraobserver and interobserver reliability on both the NWB images (mean ICC, 0.80; range, 0.49 to 0.99) and the WB images (mean ICC, 0.81; range, 0.39 to 0.99). Eighteen of 19 measurements differed between WB and NWB cone-beam CT images, with more pronounced deformities on the WB images. The most reliable measurements, based on intraobserver and interobserver reliabilities and the difference between WB and NWB images, were the medial cuneiform-to-floor distance, which averaged 29 mm (95% confidence interval [CI] = 28 to 31 mm) on the NWB images and 18 mm (95% CI = 17 to 19 mm) on the WB images, and the forefoot arch angle (mean, 13° [95% CI = 12° to 15°] and 3.0° [95% CI = 1.4° to 4.6°], respectively) in the coronal view and the cuboid-to-floor distance (mean, 22 mm [95% CI = 21 to 23 mm] and 17 mm [95% CI = 16 to 18 mm], respectively) and the navicular-to-floor distance (mean, 38 mm [95% CI = 36 to 40 mm] and 23 mm [95% CI = 22 to 25 mm], respectively) in the sagittal view.

CONCLUSIONS

Measurements analogous to traditional radiographic parameters of adult acquired flatfoot deformity are obtainable using high-resolution cone-beam CT. Compared with NWB images, WB images better demonstrated the severity of osseous derangement in patients with flexible adult acquired flatfoot deformity.

LEVEL OF EVIDENCE

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Authors+Show Affiliations

1The Johns Hopkins University, Baltimore, Maryland 2Medstar Union Memorial Hospital, Baltimore, Maryland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28926392

Citation

de Cesar Netto, Cesar, et al. "Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography." The Journal of Bone and Joint Surgery. American Volume, vol. 99, no. 18, 2017, pp. e98.
de Cesar Netto C, Schon LC, Thawait GK, et al. Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography. J Bone Joint Surg Am. 2017;99(18):e98.
de Cesar Netto, C., Schon, L. C., Thawait, G. K., da Fonseca, L. F., Chinanuvathana, A., Zbijewski, W. B., Siewerdsen, J. H., & Demehri, S. (2017). Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography. The Journal of Bone and Joint Surgery. American Volume, 99(18), e98. https://doi.org/10.2106/JBJS.16.01366
de Cesar Netto C, et al. Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography. J Bone Joint Surg Am. 2017 Sep 20;99(18):e98. PubMed PMID: 28926392.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography. AU - de Cesar Netto,Cesar, AU - Schon,Lew C, AU - Thawait,Gaurav K, AU - da Fonseca,Lucas Furtado, AU - Chinanuvathana,Apisan, AU - Zbijewski,Wojciech B, AU - Siewerdsen,Jeffrey H, AU - Demehri,Shadpour, PY - 2017/9/20/entrez PY - 2017/9/20/pubmed PY - 2017/9/25/medline SP - e98 EP - e98 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 99 IS - 18 N2 - BACKGROUND: The 3-dimensional nature of adult acquired flatfoot deformity can be challenging to characterize using radiographs. We tested the hypothesis that measurements on weight-bearing (WB) cone-beam computed tomography (CT) images were more useful for demonstrating the severity of the deformity than non-weight-bearing (NWB) measurements. METHODS: We prospectively enrolled 12 men and 8 women (mean age, 52 years; range, 20 to 88 years) with flexible adult acquired flatfoot deformity. The subjects underwent cone-beam CT while standing (WB) and seated (NWB), and images were assessed in the sagittal, coronal, and axial planes by 3 independent observers who performed multiple measurements. Intraobserver and interobserver reliabilities were assessed with the Pearson or Spearman correlation and the intraclass correlation coefficient (ICC), respectively. Measurements were compared using paired Student t tests or Wilcoxon rank-sum tests. P < 0.05 was considered significant. RESULTS: We found that overall the measurements had substantial intraobserver and interobserver reliability on both the NWB images (mean ICC, 0.80; range, 0.49 to 0.99) and the WB images (mean ICC, 0.81; range, 0.39 to 0.99). Eighteen of 19 measurements differed between WB and NWB cone-beam CT images, with more pronounced deformities on the WB images. The most reliable measurements, based on intraobserver and interobserver reliabilities and the difference between WB and NWB images, were the medial cuneiform-to-floor distance, which averaged 29 mm (95% confidence interval [CI] = 28 to 31 mm) on the NWB images and 18 mm (95% CI = 17 to 19 mm) on the WB images, and the forefoot arch angle (mean, 13° [95% CI = 12° to 15°] and 3.0° [95% CI = 1.4° to 4.6°], respectively) in the coronal view and the cuboid-to-floor distance (mean, 22 mm [95% CI = 21 to 23 mm] and 17 mm [95% CI = 16 to 18 mm], respectively) and the navicular-to-floor distance (mean, 38 mm [95% CI = 36 to 40 mm] and 23 mm [95% CI = 22 to 25 mm], respectively) in the sagittal view. CONCLUSIONS: Measurements analogous to traditional radiographic parameters of adult acquired flatfoot deformity are obtainable using high-resolution cone-beam CT. Compared with NWB images, WB images better demonstrated the severity of osseous derangement in patients with flexible adult acquired flatfoot deformity. LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/28926392/Flexible_Adult_Acquired_Flatfoot_Deformity:_Comparison_Between_Weight_Bearing_and_Non_Weight_Bearing_Measurements_Using_Cone_Beam_Computed_Tomography_ L2 - http://dx.doi.org/10.2106/JBJS.16.01366 DB - PRIME DP - Unbound Medicine ER -