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Weight-bearing radiographs and cone-beam computed tomography examinations in adult acquired flatfoot deformity.
Foot Ankle Surg. 2020 Apr 30 [Online ahead of print]FA

Abstract

BACKGROUND

Optimal characterization of Adult acquired flatfoot deformity (AAFD) on two-dimensional radiograph can be challenging. Weightbearing Cone Beam CT (CBCT) may improve characterization of the three-dimensional (3D) structural details of such dynamic deformity. We compared and validated AAFD measurements between weightbearing radiograph and weightbearing CBCT images.

METHODS

20 patients (20 feet, right/left: 15/5, male/female: 12/8, mean age: 52.2) with clinical diagnosis of flexible AAFD were prospectively recruited and underwent weightbearing dorsoplantar (DP) and lateral radiograph as well as weightbearing CBCT. Two foot and ankle surgeons performed AAFD measurements at parasagittal and axial planes (lateral and DP radiographs, respectively). Intra- and Inter-observer reliabilities were calculated by Intraclass correlation (ICC) and Cohen's kappa. Mean values of weightbearing radiograph and weightbearing CBCT measurements were also compared.

RESULTS

Except for medial-cuneiform-first-metatarsal-angle, adequate intra-observer reliability (range:0.61-0.96) was observed for weightbearing radiographic measurements. Moderate to very good interobserver reliability between weightbearing radiograph and weightbearing CBCT measurements were observed for the following measurements: Naviculocuneiform-angle (ICC:0.47), Medial-cuneiform-first-metatarsal-gapping (ICC:0.58), cuboid-to-floor-distance (ICC:0.68), calcaneal-inclination-angle(ICC:0.7), axial Talonavicular-coverage-angle(ICC:0.56), axial Talus-first-metatarsal-angle(ICC:0.62). Comparing weightbearing radiograph and weightbearing CBCT images, statistically significant differences in the mean values of parasagittal talus-first-metatarsal-angle, medial-cuneiform-first-metatarsal-angle, medial-cuneiform-to-floor-distance and navicular-to-floor-distance was observed (P < 0.05).

CONCLUSION

Moderate to very good correlation was observed between certain weightbearing radiograph and weightbearing CBCT measurements, however, significant difference was observed between a number of AAFD measurements, which suggest that 2D radiographic evaluation could potentially underestimate the severity of AAFD, when compared to 3D weightbearing CT assessment.

Authors+Show Affiliations

Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA.Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, Baltimore, MD, USA; Department of Orthopaedic Surgery and Rehabilitation, University of Iowa, Iowa City, IA, USA. Electronic address: cesar-netto@uiowa.edu.Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA.Hospital for Special Surgery, New York, NY, USA.Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany.Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, Baltimore, MD, USA.No affiliation info availableRussell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32475795

Citation

Shakoor, Delaram, et al. "Weight-bearing Radiographs and Cone-beam Computed Tomography Examinations in Adult Acquired Flatfoot Deformity." Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons, 2020.
Shakoor D, de Cesar Netto C, Thawait GK, et al. Weight-bearing radiographs and cone-beam computed tomography examinations in adult acquired flatfoot deformity. Foot Ankle Surg. 2020.
Shakoor, D., de Cesar Netto, C., Thawait, G. K., Ellis, S. J., Richter, M., Schon, L. C., & Demehri, S. (2020). Weight-bearing radiographs and cone-beam computed tomography examinations in adult acquired flatfoot deformity. Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons. https://doi.org/10.1016/j.fas.2020.04.011
Shakoor D, et al. Weight-bearing Radiographs and Cone-beam Computed Tomography Examinations in Adult Acquired Flatfoot Deformity. Foot Ankle Surg. 2020 Apr 30; PubMed PMID: 32475795.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Weight-bearing radiographs and cone-beam computed tomography examinations in adult acquired flatfoot deformity. AU - Shakoor,Delaram, AU - de Cesar Netto,Cesar, AU - Thawait,Gaurav K, AU - Ellis,Scott J, AU - Richter,Martinus, AU - Schon,Lew C, AU - ,, AU - Demehri,Shadpour, Y1 - 2020/04/30/ PY - 2019/08/16/received PY - 2020/03/15/revised PY - 2020/04/18/accepted PY - 2020/6/2/entrez KW - Cone beam computed tomography KW - Flatfoot KW - Weight-Bearing computed tomography KW - Weight-Bearing radiography JF - Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons JO - Foot Ankle Surg N2 - BACKGROUND: Optimal characterization of Adult acquired flatfoot deformity (AAFD) on two-dimensional radiograph can be challenging. Weightbearing Cone Beam CT (CBCT) may improve characterization of the three-dimensional (3D) structural details of such dynamic deformity. We compared and validated AAFD measurements between weightbearing radiograph and weightbearing CBCT images. METHODS: 20 patients (20 feet, right/left: 15/5, male/female: 12/8, mean age: 52.2) with clinical diagnosis of flexible AAFD were prospectively recruited and underwent weightbearing dorsoplantar (DP) and lateral radiograph as well as weightbearing CBCT. Two foot and ankle surgeons performed AAFD measurements at parasagittal and axial planes (lateral and DP radiographs, respectively). Intra- and Inter-observer reliabilities were calculated by Intraclass correlation (ICC) and Cohen's kappa. Mean values of weightbearing radiograph and weightbearing CBCT measurements were also compared. RESULTS: Except for medial-cuneiform-first-metatarsal-angle, adequate intra-observer reliability (range:0.61-0.96) was observed for weightbearing radiographic measurements. Moderate to very good interobserver reliability between weightbearing radiograph and weightbearing CBCT measurements were observed for the following measurements: Naviculocuneiform-angle (ICC:0.47), Medial-cuneiform-first-metatarsal-gapping (ICC:0.58), cuboid-to-floor-distance (ICC:0.68), calcaneal-inclination-angle(ICC:0.7), axial Talonavicular-coverage-angle(ICC:0.56), axial Talus-first-metatarsal-angle(ICC:0.62). Comparing weightbearing radiograph and weightbearing CBCT images, statistically significant differences in the mean values of parasagittal talus-first-metatarsal-angle, medial-cuneiform-first-metatarsal-angle, medial-cuneiform-to-floor-distance and navicular-to-floor-distance was observed (P < 0.05). CONCLUSION: Moderate to very good correlation was observed between certain weightbearing radiograph and weightbearing CBCT measurements, however, significant difference was observed between a number of AAFD measurements, which suggest that 2D radiographic evaluation could potentially underestimate the severity of AAFD, when compared to 3D weightbearing CT assessment. SN - 1460-9584 UR - https://www.unboundmedicine.com/medline/citation/32475795/Weight-bearing_radiographs_and_cone-beam_computed_tomography_examinations_in_adult_acquired_flatfoot_deformity L2 - https://linkinghub.elsevier.com/retrieve/pii/S1268-7731(20)30077-1 DB - PRIME DP - Unbound Medicine ER -