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Hindfoot alignment of adult acquired flatfoot deformity: A comparison of clinical assessment and weightbearing cone beam CT examinations.
Foot Ankle Surg. 2019 Dec; 25(6):790-797.FA

Abstract

BACKGROUND

Clinical assessment of hindfoot alignment (HA) in adult acquired flatfoot deformity (AAFD) can be challenging and weightbearing (WB) cone beam CT (CBCT) may potentially better demonstrate this three-dimensional (3D) deformity. Therefore, we compared clinical and WB CBCT assessment of HA in patients with AAFD.

METHODS

In this prospective study, we included 12 men and 8 women (mean age: 52.2, range: 20-88) with flexible AAFD. All subjects also underwent WB CBCT and clinical assessment of hindfoot alignment. Three fellowship-trained foot and ankle surgeons performed six hindfoot alignment measurements on the CT images. Intra- and Inter-observer reliabilities were calculated using intra-class correlation (ICC). Measurements were compared by paired T-tests, and p-values of less than 0.05 were considered significant.

RESULTS

The mean of clinically measured hindfoot valgus was 15.2 (95% confidence interval [CI]: 11.5-18.8) degrees. It was significantly different from the mean values of all WB CBCT measurements: Clinical Hindfoot Alignment Angle, 9.9 (CI: 8.9-11.1) degrees; Achilles tendon/Calcaneal Tuberosity Angle, 3.2 (CI: 1.3-5.0) degrees; Tibial axis/Calcaneal Tuberosity Angle, 6.1 (CI: 4.3-7.8) degrees; Tibial axis/Subtalar Joint Angle 7.0 (CI: 5.3-8.8) degrees, and Hindfoot Alignment Angle 22.8 (CI: 20.4-25.3) degrees. We found overall substantial to almost perfect intra- (ICC range: 0.87-0.97) and inter-observer agreements (ICC range: 0.51-0.88) for all WB CBCT measurements.

CONCLUSIONS

Using 3D WB CBCT can help characterize the valgus hindfoot alignment in patients with AAFD. We found the different CT measurements to be reliable and repeatable, and to significantly differ from the clinical evaluation of hindfoot valgus alignment.

LEVEL OF EVIDENCE

Level II-prospective comparative study.

Authors+Show Affiliations

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States; Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States; Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States. Electronic address: cesardecesarnetto@gmail.com.Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States.Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States; Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States.Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States; Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States.Foot and Ankle Surgery Department, Clinique de l'Union, Saint-Jean, Toulouse, France.Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States.Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30455094

Citation

de Cesar Netto, Cesar, et al. "Hindfoot Alignment of Adult Acquired Flatfoot Deformity: a Comparison of Clinical Assessment and Weightbearing Cone Beam CT Examinations." Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons, vol. 25, no. 6, 2019, pp. 790-797.
de Cesar Netto C, Shakoor D, Roberts L, et al. Hindfoot alignment of adult acquired flatfoot deformity: A comparison of clinical assessment and weightbearing cone beam CT examinations. Foot Ankle Surg. 2019;25(6):790-797.
de Cesar Netto, C., Shakoor, D., Roberts, L., Chinanuvathana, A., Mousavian, A., Lintz, F., Schon, L. C., & Demehri, S. (2019). Hindfoot alignment of adult acquired flatfoot deformity: A comparison of clinical assessment and weightbearing cone beam CT examinations. Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons, 25(6), 790-797. https://doi.org/10.1016/j.fas.2018.10.008
de Cesar Netto C, et al. Hindfoot Alignment of Adult Acquired Flatfoot Deformity: a Comparison of Clinical Assessment and Weightbearing Cone Beam CT Examinations. Foot Ankle Surg. 2019;25(6):790-797. PubMed PMID: 30455094.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hindfoot alignment of adult acquired flatfoot deformity: A comparison of clinical assessment and weightbearing cone beam CT examinations. AU - de Cesar Netto,Cesar, AU - Shakoor,Delaram, AU - Roberts,Lauren, AU - Chinanuvathana,Apisan, AU - Mousavian,Alireza, AU - Lintz,Francois, AU - Schon,Lew C, AU - Demehri,Shadpour, AU - ,, Y1 - 2018/11/05/ PY - 2018/07/25/received PY - 2018/10/16/accepted PY - 2018/11/21/pubmed PY - 2020/3/12/medline PY - 2018/11/21/entrez KW - Adult acquired flatfoot deformity KW - Cone beam CT KW - Flatfoot KW - Hindfoot alignment KW - Weightbearing KW - Weightbearing CT SP - 790 EP - 797 JF - Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons JO - Foot Ankle Surg VL - 25 IS - 6 N2 - BACKGROUND: Clinical assessment of hindfoot alignment (HA) in adult acquired flatfoot deformity (AAFD) can be challenging and weightbearing (WB) cone beam CT (CBCT) may potentially better demonstrate this three-dimensional (3D) deformity. Therefore, we compared clinical and WB CBCT assessment of HA in patients with AAFD. METHODS: In this prospective study, we included 12 men and 8 women (mean age: 52.2, range: 20-88) with flexible AAFD. All subjects also underwent WB CBCT and clinical assessment of hindfoot alignment. Three fellowship-trained foot and ankle surgeons performed six hindfoot alignment measurements on the CT images. Intra- and Inter-observer reliabilities were calculated using intra-class correlation (ICC). Measurements were compared by paired T-tests, and p-values of less than 0.05 were considered significant. RESULTS: The mean of clinically measured hindfoot valgus was 15.2 (95% confidence interval [CI]: 11.5-18.8) degrees. It was significantly different from the mean values of all WB CBCT measurements: Clinical Hindfoot Alignment Angle, 9.9 (CI: 8.9-11.1) degrees; Achilles tendon/Calcaneal Tuberosity Angle, 3.2 (CI: 1.3-5.0) degrees; Tibial axis/Calcaneal Tuberosity Angle, 6.1 (CI: 4.3-7.8) degrees; Tibial axis/Subtalar Joint Angle 7.0 (CI: 5.3-8.8) degrees, and Hindfoot Alignment Angle 22.8 (CI: 20.4-25.3) degrees. We found overall substantial to almost perfect intra- (ICC range: 0.87-0.97) and inter-observer agreements (ICC range: 0.51-0.88) for all WB CBCT measurements. CONCLUSIONS: Using 3D WB CBCT can help characterize the valgus hindfoot alignment in patients with AAFD. We found the different CT measurements to be reliable and repeatable, and to significantly differ from the clinical evaluation of hindfoot valgus alignment. LEVEL OF EVIDENCE: Level II-prospective comparative study. SN - 1460-9584 UR - https://www.unboundmedicine.com/medline/citation/30455094/Hindfoot_alignment_of_adult_acquired_flatfoot_deformity:_A_comparison_of_clinical_assessment_and_weightbearing_cone_beam_CT_examinations_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1268-7731(18)30301-1 DB - PRIME DP - Unbound Medicine ER -