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Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity.
Foot Ankle Int. 2020 Jul; 41(7):839-848.FA

Abstract

BACKGROUND

Semiautomatic 3-dimensional (3D) biometric weightbearing computed tomography (WBCT) tools have been shown to adequately demonstrate the relationship between the center of the ankle joint and the tripod of the foot. The measurement of the foot and ankle offset (FAO) represents an optimized biomechanical assessment of foot alignment. The objective of this study was to evaluate the correlation between FAO and traditional adult acquired flatfoot deformity (AAFD) markers, measured in different planes. We hypothesized that the FAO would significantly correlate with other radiographic markers of pronounced AAFD.

METHODS

In this retrospective comparative study, we included 113 patients with stage II AAFD, 43 men and 70 women, mean age of 53.5 (range, 20-86) years. 3D coordinates (x, y, and z planes) of the foot tripod (most plantar voxel of the first and fifth metatarsal heads, and calcaneal tuberosity) and the center of the ankle joint (most proximal and central voxel of the talar dome) were assessed by 2 blinded and independent fellowship-trained orthopedic foot and ankle surgeons. The FAO was automatically calculated using the 3D coordinates by dedicated software. Multiple WBCT parameters related to the severity of the deformity in the coronal, sagittal, and transverse planes were manually measured.

RESULTS

We found overall good to excellent intra- (range, 0.75-0.99) and interobserver (range, 0.73-0.99) reliability for manual AAFD measurements. FAO semiautomatic measurements demonstrated excellent intra- (0.99) and interobserver (0.99) reliabilities. Hindfoot moment arm (HMA) (P < .00001), subtalar horizontal angle (P < .00001), talonavicular coverage angle (P = .00004), and forefoot arch angle (P = .0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R2 value of 0.79. An HMA value of 19.8 mm was found to be a strong threshold predictor of increased values of FAO, with mean values of FAO of 6.5 when the HMA was lower than 19.8 mm and 14.6 when the HMA was equal to or higher than 19.8 mm.

CONCLUSION

We found that 3D WBCT semiautomatic measurements of FAO significantly correlated with some traditional markers of pronounced AAFD. Measurements of FAO were also found to be slightly more reliable than the manual measurements. The FAO offers a simple and more complete biomechanical and multiplanar assessment of the AAFD, representing in a single measurement the 3D components of the deformity.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Authors+Show Affiliations

Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA. Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil.Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK.Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France.Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32441540

Citation

de Cesar Netto, Cesar, et al. "Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity." Foot & Ankle International, vol. 41, no. 7, 2020, pp. 839-848.
de Cesar Netto C, Bang K, Mansur NS, et al. Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity. Foot Ankle Int. 2020;41(7):839-848.
de Cesar Netto, C., Bang, K., Mansur, N. S., Garfinkel, J. H., Bernasconi, A., Lintz, F., Deland, J. T., & Ellis, S. J. (2020). Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity. Foot & Ankle International, 41(7), 839-848. https://doi.org/10.1177/1071100720920274
de Cesar Netto C, et al. Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity. Foot Ankle Int. 2020;41(7):839-848. PubMed PMID: 32441540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity. AU - de Cesar Netto,Cesar, AU - Bang,Katrina, AU - Mansur,Nacime Salomao, AU - Garfinkel,Jonathan H, AU - Bernasconi,Alessio, AU - Lintz,Francois, AU - Deland,Jonathan T, AU - Ellis,Scott J, Y1 - 2020/05/22/ PY - 2020/5/23/pubmed PY - 2020/5/23/medline PY - 2020/5/23/entrez KW - AAFD KW - FAO KW - WBCT KW - adult acquired flatfoot deformity KW - flatfoot KW - foot and ankle offset KW - hindfoot alignment KW - measurements KW - weightbearing CT KW - weightbearing computed tomography SP - 839 EP - 848 JF - Foot & ankle international JO - Foot Ankle Int VL - 41 IS - 7 N2 - BACKGROUND: Semiautomatic 3-dimensional (3D) biometric weightbearing computed tomography (WBCT) tools have been shown to adequately demonstrate the relationship between the center of the ankle joint and the tripod of the foot. The measurement of the foot and ankle offset (FAO) represents an optimized biomechanical assessment of foot alignment. The objective of this study was to evaluate the correlation between FAO and traditional adult acquired flatfoot deformity (AAFD) markers, measured in different planes. We hypothesized that the FAO would significantly correlate with other radiographic markers of pronounced AAFD. METHODS: In this retrospective comparative study, we included 113 patients with stage II AAFD, 43 men and 70 women, mean age of 53.5 (range, 20-86) years. 3D coordinates (x, y, and z planes) of the foot tripod (most plantar voxel of the first and fifth metatarsal heads, and calcaneal tuberosity) and the center of the ankle joint (most proximal and central voxel of the talar dome) were assessed by 2 blinded and independent fellowship-trained orthopedic foot and ankle surgeons. The FAO was automatically calculated using the 3D coordinates by dedicated software. Multiple WBCT parameters related to the severity of the deformity in the coronal, sagittal, and transverse planes were manually measured. RESULTS: We found overall good to excellent intra- (range, 0.75-0.99) and interobserver (range, 0.73-0.99) reliability for manual AAFD measurements. FAO semiautomatic measurements demonstrated excellent intra- (0.99) and interobserver (0.99) reliabilities. Hindfoot moment arm (HMA) (P < .00001), subtalar horizontal angle (P < .00001), talonavicular coverage angle (P = .00004), and forefoot arch angle (P = .0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R2 value of 0.79. An HMA value of 19.8 mm was found to be a strong threshold predictor of increased values of FAO, with mean values of FAO of 6.5 when the HMA was lower than 19.8 mm and 14.6 when the HMA was equal to or higher than 19.8 mm. CONCLUSION: We found that 3D WBCT semiautomatic measurements of FAO significantly correlated with some traditional markers of pronounced AAFD. Measurements of FAO were also found to be slightly more reliable than the manual measurements. The FAO offers a simple and more complete biomechanical and multiplanar assessment of the AAFD, representing in a single measurement the 3D components of the deformity. LEVEL OF EVIDENCE: Level III, retrospective comparative study. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/32441540/Multiplanar_Semiautomatic_Assessment_of_Foot_and_Ankle_Offset_in_Adult_Acquired_Flatfoot_Deformity L2 - https://journals.sagepub.com/doi/10.1177/1071100720920274?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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