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  • 1
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    Online Resource
    Effect of Peritalar Subluxation Correction for Progressive Collapsing Foot Deformity on Patient-Reported Outcomes
    SAGE Publications ; 2023
    In:  Foot & Ankle International
    Details
    In: Foot & Ankle International, SAGE Publications
    Abstract: Peritalar subluxation (PTS) is part of progressive collapsing foot deformity (PCFD). This study aimed to evaluate initial deformity correction and PTS optimization in PCFD patients with flexible hindfoot deformity undergoing hindfoot joint-sparing surgical procedures and its relationship with improvements in patient-reported outcome measures (PROMs) at latest follow-up. We hypothesized that significant deformity/PTS correction would be observed postoperatively, positively correlating with improved PROMs. Methods: A prospective comparative study was performed with 26 flexible PCFD patients undergoing hindfoot joint-sparing reconstructive procedures, mean age 47.1 years (range, 18-77). We assessed weightbearing computed tomography (WBCT) overall deformity (foot and ankle offset [FAO]) and PTS markers (distance and coverage maps) at 3 months, as well as PROMs at final follow-up. A multivariate regression model assessed the influence of initial deformity correction and PTS optimization in patient-reported outcomes. Results: Mean follow-up was 19.9 months (6-39), and the average number of procedures performed was 4.8 (2-8). FAO improved from 9.4% (8.4-10.9) to 1.9% (1.1-3.6) postoperatively ( P  〈  .0001). Mean coverage improved by 69.6% ( P = .012), 12.1% ( P = .0343) and 5.2% ( P = .0074) in, respectively, the anterior, middle, and posterior facets, whereas the sinus tarsi coverage decreased by an average 57.1% ( P  〈  .0001) postoperatively. Improvements in patient-reported outcomes were noted for all scores assessed ( P  〈  .03). The multivariate regression analysis demonstrated that improvement in both FAO and PTS measurements significantly influenced the assessed PROMs. Conclusion: This study demonstrated significant improvements in the overall 3D deformity, PTS markers, and PROMs following hindfoot joint-sparing surgical treatment in patients with flexible PCFD. More importantly, initial 3D deformity correction and improvement in subtalar joint coverage and extraarticular impingement have been shown to influence PROMs significantly and positively. Addressing these variables should be considered as goals when treating PCFD. Level of Evidence: Level II, prospective cohort study.
    Type of Medium: Online Resource
    ISSN: 1071-1007 , 1944-7876
    URL: Article
    DOI: 10.1177/10711007231192479
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2129503-7
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  • 2
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    Minimally invasive chevron/akin osteotomy: radiographic outcomes
    Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe) ; 2021
    In:  Journal of the Foot & Ankle Vol. 15, No. 2 ( 2021-08-31), p. 110-114
    Details
    In: Journal of the Foot & Ankle, Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe), Vol. 15, No. 2 ( 2021-08-31), p. 110-114
    Abstract: Objective: To evaluate radiographic outcomes in patients undergoing minimally invasive Chevron/Akin osteotomy (MICA) for hallux valgus correction. Methods: We have treated 31 patients (40 feet). Preoperative and postoperative hallux metatarsophalangeal angles (hallux valgus angles, HVA), intermetatarsal angles (IMA) between the first and second metatarsals, and distal metatarsal articular angles (DMAA) were followed up for 12 months. Results: The mean age of the patients was 53.2 years. Mean preoperative HVA, IMA, and DMAA values were 28.85°, 15.38°, and 14.35°, respectively. The mean postoperative angles measured after 1 year were 10.60°, 7.95°, and 7.48°. Improvements in HVA, IMA, and DMAA values showed statistical relevance. There were no losses in angular parameters during follow-up. Conclusion: The radiographic outcomes in patients undergoing MICA osteotomy for hallux valgus correction followed up for 12 months showed significant improvements and no recurrence of the deformity. Our results suggest that this technique is effective for correcting hallux valgus. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.
    Type of Medium: Online Resource
    ISSN: 2675-2980
    URL: Article
    DOI: 10.30795/jfootankle.2021.v15.1563
    Language: Unknown
    Publisher: Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe)
    Publication Date: 2021
    detail.hit.zdb_id: 3040308-X
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  • 3
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    Coronal Plane Rotation of the Medial Column in Hallux Valgus: A Retrospective Case-Control Study
    SAGE Publications ; 2022
    In:  Foot & Ankle International Vol. 43, No. 8 ( 2022-08), p. 1041-1048
    Details
    In: Foot & Ankle International, SAGE Publications, Vol. 43, No. 8 ( 2022-08), p. 1041-1048
    Abstract: We previously reported an increase in pronation of the first metatarsal (M1) head relative to the ground in hallux valgus (HV) patients compared to controls. Still, the origin and location of this hyperpronation along the medial column is unknown. Recent studies showed that presence of progressive collapsing foot deformities (PCFDs), which is a condition frequently associated with HV, can strongly influence the medial column coronal plane alignment. The objective of this study was to assess the coronal rotation of the medial column bones in HV feet, HV feet with radiologic markers of PCFD, and controls. We hypothesized that hyperpronation in HV will originate from a combination of M1 intrinsic torsion and first tarsometatarsal joint malposition. Methods: The same cohort of 36 HV and 20 controls matched on age, gender, and body mass index was used. Previously, a validation of the measurements was carried out through a cadaveric study. Using these metrics, we assessed the coronal plane rotation of the navicular, medial cuneiform, and the M1 at its base and head with respect to the ground using weightbearing CT images. We measured the Meary angle and the calcaneal moment arm in our 36 HV subjects. We subdivided our cohort into an HV group and a potential PCFD HV group according to these measurements. Comparisons on medial column bones coronal rotation were performed between HV, PCFD HV, and control groups. Results: Twenty-two HV cases were included in the HV group and 14 in the PCFD HV group. Both groups presented an increase in pronation of the first metatarsal head relative to the ground when compared to the control group ( P 〈 .001). Comparing HV and controls showed an 8.3 degrees increase in pronation of M1 intrinsic torsion ( P 〈 .001) and a 4.7 degrees pronated malposition of the first tarsometatarsal joint ( P = .02) in HV. A 9.7 degrees supinated malposition of the first naviculocuneiform joint ( P 〈 .001) was also observed in HV. Comparing PCFD HV and controls showed a significant increase in pronation of the navicular (respectively, 17.2 ± 5.4 and 12.3 ± 3.4 degrees, P = .007) and a 5.5 degrees increase in pronation of M1 intrinsic torsion ( P = .02) in PCFD HV, without malposition of the first tarsometatarsal and naviculocuneiform joints. Conclusion: Hyperpronation of the M1 head relative to the ground originated from both increases in pronation of M1 intrinsic torsion and first tarsometatarsal joint malposition in HV, although partially counterbalanced by a supinated malposition of the first naviculocuneiform joint. On the other hand, PCFD HV patients showed a generalized pronated position throughout the medial column from the navicular to the M1 head and may be related to the midfoot and hindfoot deformities frequently present in PCFD. Level of Evidence: Level III, retrospective comparative study.
    Type of Medium: Online Resource
    ISSN: 1071-1007 , 1944-7876
    URL: Article
    DOI: 10.1177/10711007221091810
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2129503-7
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  • 4
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    The Use of Advanced Semiautomated Bone Segmentation in Hallux Rigidus
    SAGE Publications ; 2022
    In:  Foot & Ankle Orthopaedics Vol. 7, No. 4 ( 2022-10), p. 247301142211375-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 7, No. 4 ( 2022-10), p. 247301142211375-
    Abstract: Weightbearing computed tomography (WBCT) measurements allow evaluation of several anatomical points for a correct clinical-radiographic diagnosis of pathologies, such as hallux rigidus (HR). In addition, a new semiautomatic segmentation software obtains automated 3D measurements from WBCT scan data sets, minimizing errors in reading angular measurements. The study’s objective was (1) to evaluate the reliability of WBCT semiautomatic imaging measures in HR, (2) to evaluate correlation and agreement between manual and semiautomatic measures in the setting of HR, and (3) to compare semiautomatic measurements between pathologic (HR) and standard control groups. Methods: A retrospective study of HR patients was performed including 20 feet with HR. WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first metatarsal-proximal phalanx angle (1stMPP), (2) hallux valgus angle (HVA), (3) first to second intermetatarsal angle (IMA), (4) hallux interphalangeal angle (IPA), (5) first metatarsal length (1stML), (6) second metatarsal length (2ndML), (7) first metatarsal declination angle (1stMD), (8) second metatarsal declination angles (2ndMD), and (9) metatarsus primus elevatus (MPE). The differences between pathologic and control cases were assessed with a Wilcoxon test. Results: Interobserver and intraobserver agreement for manual vs semiautomatic WBCT measurements demonstrated excellent reliability. According to the Pearson coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA (ρ = 0.96), IMA (ρ = 0.86), IPA (ρ = 0.89), 1stML (ρ = 0.96), 2ndML (ρ = 0.91), 1stMD (ρ = 0.86), 2ndMD (ρ = 0.95), and MPE (ρ = 0.87). Comparison between the pathologic group with HR and the control (standard) group allowed for the differentiating of the pathologic (HR) from the non-pathologic conditions for MPE (p 〈 0.05). Conclusion: Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement. The software used differentiated pathologic from nonpathologic conditions when submitted to semiautomatic MPE measurements. Level of Evidence: Level III, retrospective comparative study.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/24730114221137597
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2874570-X
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  • 5
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    Quantification of First Metatarsal Joint Surface Interactions in Hallux Rigidus Using Distance and Coverage Mapping: A Case-Control Study
    SAGE Publications ; 2024
    In:  Foot & Ankle International Vol. 45, No. 9 ( 2024-09), p. 1038-1046
    Details
    In: Foot & Ankle International, SAGE Publications, Vol. 45, No. 9 ( 2024-09), p. 1038-1046
    Abstract: Weightbearing cone-beam computed tomography (WBCT) has proven useful for analysis of structural changes of the foot and ankle when compared to conventional radiographs. WBCT allows for extraction of distance and coverage mapping metrics, which may provide novel insight into hallux rigidus (HR). This study retrospectively assessed HR joint space using distance and coverage mapping in a case-control study. Methods: WBCT images of the foot and ankle for 20 symptomatic HR and 20 control patients were obtained. Three-dimensional models were created and analyzed using a custom semiautomatic measurement algorithm. Distance and coverage mapping metrics for the first metatarsophalangeal and metatarsosesamoid joints were extracted from the models and compared between cohorts. Relationships between these metrics and visual analog scale (VAS) scores, a patient-reported outcome of pain, were assessed in HR patients. Results: Overall first metatarsophalangeal joint space narrowing was noted in HR patients when compared to controls by an average of 11.8% ( P = .02). However, no significant changes in the overall coverage of the joint were noted. Decreased joint space width and increased surface-to-surface coverage were only and particularly observed at the plantar medial quadrant of the first metatarsal head in HR patients relative to controls. VAS score was significantly but weakly correlated with dorsolateral quadrant coverage ( R 2 = 0.26, P = .03). Conclusion: Distance and coverage mapping serve as a complementary option to current techniques of quantifying HR changes. These metrics can expand the scope of future work investigating joint articulation changes in HR.
    Type of Medium: Online Resource
    ISSN: 1071-1007 , 1944-7876
    URL: Article
    DOI: 10.1177/10711007241258447
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2024
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  • 6
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    Minimally Invasive Chevron Akin Osteotomy: Preoperative Planning Using the Radiographic First-Ray Squeeze Test
    SAGE Publications ; 2024
    In:  Foot & Ankle Orthopaedics Vol. 9, No. 1 ( 2024-01)
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 9, No. 1 ( 2024-01)
    Abstract: Recognizing preoperative first-ray hypermobility is important to planning hallux valgus (HV) surgery. A recent study showed the minimally invasive chevron Akin (MICA) osteotomy increased varus displacement of the proximal fragment of the first metatarsal osteotomy. The present study aims to evaluate the ability of the radiographic first-ray squeeze test to predict the varus displacement of the proximal fragment of the first metatarsal osteotomy when performing the MICA procedure. Methods: A prospective case series of patients with moderate to severe HV who underwent MICA was performed. The HV deformity correction was analyzed by comparing the preoperative and 12-week postoperative hallux valgus angle (HVA) and the intermetatarsal angle between the first and second rays (1-2 IMA). The ability of the radiographic first-ray squeeze test to predict the varus displacement of the first metatarsal was done by comparing the preoperative 1-2 IMA measured in the AP radiographic first-ray squeeze test (IMA-ST) with the intermetatarsal angle between the second metatarsal and the axis of the first metatarsal osteotomy proximal fragment (IAPF) taken 12 weeks postoperatively. Results: Between July 2022 and May 2023, a total of 39 feet in 28 patients underwent MICA. The mean IMA improved from 13.8 (SD = 2.2) to 3.8 degrees (SD = 1.5) ( P 〈 .001), and the mean HVA improved from 27.8 (SD = 6.1) to 4.9 degrees (SD = 2.5) ( P 〈 .001). A linear regression analysis revealed that IMA-ST is highly associated with the 12 week assessed IAPF ( P 〈 .001). Conclusion: The preoperative radiographic first-ray squeeze test appears to predict with high fidelity the varus displacement of the proximal fragment of the first metatarsal that can occur after the MICA procedure. Level of Evidence: Level III, prospective cohort study.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/24730114241239331
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2024
    detail.hit.zdb_id: 2874570-X
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  • 7
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    Online Resource
    Hallux valgus measurements using weight-bearing computed tomography: what changes?
    Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe) ; 2021
    In:  Journal of the Foot & Ankle Vol. 15, No. 3 ( 2021-12-20), p. 259-264
    Details
    In: Journal of the Foot & Ankle, Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe), Vol. 15, No. 3 ( 2021-12-20), p. 259-264
    Abstract: Objective: To assess whether traditional hallux valgus (HV) measurements obtained with conventional radiography (CR) correspond to those obtained with weight-bearing computed tomography (WBCT). Methods: In this retrospective case-control study, 26 HV feet and 20 control feet were analyzed with CR and WBCT. Hallux valgus angle (HVA), intermetatarsal angle (IMA), interphalangeal angle (IPA), distal metatarsal articular angle (DMAA), sesamoid station (SS), and first metatarsal head shape were measured. Chi-square tests were used to compare hallux valgus and control patients. T-tests were used to compare CR and WBCT. P-values less than 0.05 were considered significant. Results: WBCT was capable of discriminating patients with HV from controls, showing higher mean values for HV patients than controls in HVA (35.29 and 9.02, p 〈 0.001), IMA (16.01 and 10.01, p 〈 0.001), and DMAA (18.90 and 4.10, p 〈 0.001). When comparing the two methods, differences were not significant between CR and WBCT measurements in HVA (-0.84, p = 0.79), IMA (-0.93, p = 0.39), IPA (1.53, p = 0.09), or SS (p = 0.40), but were significant for DMAA (13.43, p 〈 .0001). CR analysis yielded varied metatarsal head shapes, while all WBCT shape classifications were round.  Conclusion: Unidimensional HV measurements were similar between WBCT and CR, while more three-dimensional findings were not. CR may be used to assess the axial aspects of HV, but multidimensional aspects of the deformity may not be accurately assessed with plain radiographs. Level of Evidence III; Therapeutic Studies; Retrospective Case-Control Study.
    Type of Medium: Online Resource
    ISSN: 2675-2980
    URL: Article
    DOI: 10.30795/jfootankle.2021.v15.1600
    Language: Unknown
    Publisher: Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe)
    Publication Date: 2021
    detail.hit.zdb_id: 3040308-X
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  • 8
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    Ankle syndesmotic instability assessment using a three-dimensional distance mapping algorithm: a cadaveric pilot WBCT study
    Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe) ; 2022
    In:  Journal of the Foot & Ankle Vol. 16, No. 3 ( 2022-12-20), p. 190-194
    Details
    In: Journal of the Foot & Ankle, Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe), Vol. 16, No. 3 ( 2022-12-20), p. 190-194
    Abstract: Objective: This cadaveric pilot study was to develop a weight bearing computed tomography (WBCT) three-dimensional (3D) distance mapping algorithm that would allow for detection of syndesmotic instability. Methods: Pilot study, two cadaveric specimens. Syndesmotic instability was induced by release of all syndesmotic ligaments through a conventional lateral ankle approach. WBCT imaging under simulated weight bearing was acquired before and after syndesmotic destabilization. Syndesmotic incisura and ankle gutter distances were assessed using a 3D distance mapping WBCT algorithm. Results: We found increases in the overall mean syndesmotic distances in the injured syndesmosis when compared to pre-injury state, and color coded distance maps allowed easy interpretation of the syndesmotic widening following ligament sectioning and destabilization of the syndesmotic joint. Conclusion: The WBCT 3D distance mapping algorithm has the potential to allow detection of mild syndesmotic instability with a relatively ease of interpretation by using color-coded distance maps. Level of Evidence V; Cadaveric Study.
    Type of Medium: Online Resource
    ISSN: 2675-2980
    URL: Article
    DOI: 10.30795/jfootankle.2022.v16.1673
    Language: Unknown
    Publisher: Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe)
    Publication Date: 2022
    detail.hit.zdb_id: 3040308-X
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  • 9
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    Agreement between semiautomatic and manual measurement of selected parameters on weight-bearing computed tomography images in total ankle replacement: a retrospective study
    Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe) ; 2022
    In:  Journal of the Foot & Ankle Vol. 16, No. 1 ( 2022-04-30), p. 72-78
    Details
    In: Journal of the Foot & Ankle, Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe), Vol. 16, No. 1 ( 2022-04-30), p. 72-78
    Abstract: Objective: To assess the agreement between semiautomatic 3D measurements and manual measurements derived from WBCT images in patients with end-stage ankle osteoarthritis (AO) who underwent total ankle replacement (TAR). Methods: In this retrospective, IRB-approved study (ID #201904825), we evaluated patients who underwent TAR via the lateral trans-fibular approach for end-stage ankle OA. The study included 14 ankles from 14 patients. Raw multiplanar data were analyzed using CubeVue® software. Lateral talar station (LTS) was obtained in the sagittal plane, while hindfoot moment arm (HMA) and talar tilt angle (TTA) were calculated in the coronal view. Semiautomatic 3D measurements were performed using Disior® software. Intra-rater reliabilities were analyzed using the intraclass correlation coefficient (ICC). Agreement between methods was tested with Bland-Altman plots. Each measurement was assessed using the Wilcoxon signed-rank test. Alpha risk was set to 5% (α=0.05). P-values of ≤0.05 were considered significant. Results: ICC-measured reliabilities ranged from moderate to almost perfect for manual and semiautomatic WBCT measurements in the preoperative and postoperative groups for HMA and LTS. There was high correlation between parameters calculated from manual and semiautomatic measurements, and strong agreement between the readers and software in both groups. Conclusions: Manual (M) and semiautomatic (SA) 3D measurements expressed excellent agreement for pre- and postoperative groups, indicating a high correlation between the parameters calculated and strong agreement between the readers and the software in both groups. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.
    Type of Medium: Online Resource
    ISSN: 2675-2980
    URL: Article
    DOI: 10.30795/jfootankle.2022.v16.1631
    Language: Unknown
    Publisher: Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe)
    Publication Date: 2022
    detail.hit.zdb_id: 3040308-X
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  • 10
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    Reliability of coronal plane rotation measurements in the medial column of the foot: a cadaveric study
    Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe) ; 2021
    In:  Journal of the Foot & Ankle Vol. 15, No. 3 ( 2021-12-20), p. 252-258
    Details
    In: Journal of the Foot & Ankle, Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe), Vol. 15, No. 3 ( 2021-12-20), p. 252-258
    Abstract: Objective: To assess interobserver reliability of previously described coronal plane rotation measurements of medial column bones and to assess their ability to accurately quantify changes in rotational profile. Methods: Two cadaveric below-knee specimens were implanted with pins in each bone of the medial column. Weight-bearing computed tomography (CT) scans were acquired in a simulated standing position under neutral, supinated, and pronated conditions. For each specimen and condition, 2 observers measured the coronal plane rotation of the navicular, medial cuneiform, first metatarsal base, shaft, and head, and proximal phalanx of the hallux as previously described. The rotation of each pin was measured relative to the ground in the coronal plane for each condition. These measurements were defined as benchmarks for the rotational profile of each bone. The correlation between these benchmarks and direct bone measurements was then assessed. Intraclass correlation coeficiente was used to assess interobserver reliability. Pearson’s coefficient was used to evaluate correlations. Results: The interobserver reliability of direct bone measurements ranged from 0.98 to 0.99. Correlations between pin rotation and direct measurements ranged from ρ=0.87 to 0.99 across the neutral, supinated, and pronated conditions. Conclusion: Coronal plane rotation measurements of medial column bones described in this study are reliable tools. Level of Evidence III; Case-Control Study.
    Type of Medium: Online Resource
    ISSN: 2675-2980
    URL: Article
    DOI: 10.30795/jfootankle.2021.v15.1598
    Language: Unknown
    Publisher: Associacao Brasileira de Medicina e Cirurgia do Tornozelo e Pe (ABTPe)
    Publication Date: 2021
    detail.hit.zdb_id: 3040308-X
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