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  • 1
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0005-
    Abstract: Hindfoot; Ankle; Other Introduction/Purpose: Semi-automatic three-dimensional (3D) biometric weightbearing CT (WBCT) tools have been shown to accurately 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 to 86) years. Three-dimensional 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 harvested by two 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 plane were manually measured. Results: We found overall good to excellent intra (range, 0.84-0.99) and interobserver reliability (range, 0.71-0.96) for manual AAFD measurements. FAO semi-automatic measurements demonstrated excellent intra (0.99) and interobserver reliabilities (0.98). Hindfoot moment arm (p 〈 0.00001), subtalar horizontal angle (p 〈 0.00001), talonavicular uncoverage angle (p=0.00004) and forefoot arch angle (p=0.0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R-squared value of 0.79. A value of hindfoot moment arm of 19.8mm 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 19.8mm and 14.6 when the HMA was equal or higher than 19.8mm. Conclusion: We found that 3D WBCT semi-automatic measurements of Foot and Ankle Offset (FAO) significantly correlated with traditional markers of pronounced AAFD. HMA, subtalar horizontal angle, talonavicular uncoverage angle and forefoot arch angle were found to explain 79% of the variations in FAO measurements. FAO Measurements were also found to be more reliable than the manual measurements. The FAO offers a more complete biomechanical and multiplanar assessment of the AAFD, that that accounts for relative positioning of the foot tripod and the center of the ankle joint, representing in a single measurement the three-dimensional components of the deformity.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 2
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    Online Resource
    SAGE Publications ; 2020
    In:  Foot & Ankle Orthopaedics Vol. 5, No. 1 ( 2020-01-01), p. 247301141989791-
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 5, No. 1 ( 2020-01-01), p. 247301141989791-
    Abstract: Perioperative opioid consumption has received a great deal of recent attention. However, perioperative opioid utilization in the total ankle arthroplasty (TAA) population has not been well studied. We sought to identify factors associated with postoperative opioid use following TAA. Methods: The PearlDiver Research Program was used to query the Humana, Inc, administrative claims database from 2007 to 2017 for patients undergoing TAA. Additional variables of interest were identified using ICD-9 and ICD-10 codes. Preoperative opioid use was defined as having filled an opioid prescription in the 3 months before TAA. Prescription opioid claims data were tracked for 12 months postoperatively. Risk ratios (RRs) were calculated and multivariate analysis was performed at 3, 6, and 12 months postoperatively. Results: A total of 544 patients who underwent TAA were identified, with 180 (33.1%) filling an opioid prescription preoperatively. Those filling prescriptions preoperatively had a significantly greater risk for postoperative opioid use compared to those not taking opioids (RR: 4.36 [95% confidence interval (CI): 2.80-6.80] at 12 months). Anxiety or depression (RR: 2.27 [1.44-3.59] ), low back pain (LBP) (RR: 2.27 [1.50-3.42]), and fibromyalgia (RR: 2.15 [1.42-3.28] ) were also found to increase the risk of taking opioids at 12 months postoperatively. Multivariate analysis found preoperative opioid use to be the strongest predictor of postoperative opioid use. Conclusions: Nearly one-third of patients filled an opioid prescription within 3 months of TAA, and filling a prescription preoperatively was the strongest factor associated with postoperative opioid use. Fibromyalgia, depression or anxiety, and LBP were also associated with an increased likelihood of postoperative opioid use. Level of Evidence: Level III, retrospective cohort study.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 3
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0003-
    Abstract: Hindfoot; Ankle; Other Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) is a three-dimensional (3D) and complex pathology that is characterized by peritalar subluxation (PTS) of the hindfoot. Measuring the amount of subluxation of the subtalar joint at the posterior facet was described and utilized for many years as a marker of PTS. The subluxation of the middle facet was recently proposed as possibly a more accurate and reliable early marker of pronounced deformity, with almost 100% sensitivity and specificity for symptomatic AAFD. The objective of this study was to compare the amount of subluxation of both the medial and posterior facets in patients with increased hindfoot valgus and controls. Methods: In this IRB-approved retrospective comparative study, we included a total of 91 patients with AAFD (108 feet) who underwent standing weightbearing CT (WBCT) as a standard baseline assessment of their foot deformity. One blinded Fellowship- Trained Orthopedic Foot and Ankle Surgeon with more than 10 years of experience performed WBCT measurements regarding the amount of subluxation of the subtalar joint (percentage of uncoverage) at the posterior and middle facet, as previously described in the literature (Please see attached Figure). Measurements were performed at the sagittal midpoint of the articular facets using Coronal Plane WBCT images. The inter-method agreement between the posterior and middle facet subluxation was assessed using Spearman’s Correlation and Bivariate Analysis. A paired comparison of the measurements was performed using Wilcoxon. P-values of 〈 0.05 were considered significant. Results: The inter-method Spearman’s correlation between the subluxation of posterior and middle facets was measured 0.69. In a bivariate analysis, both measurements were found to be significantly and linearly correlated (P 〈 0.0001), (R2=0.5). The mean/median value and 95% Confidence Interval (CI) for subluxation of the subtalar joint facets were found to be more pronounced in the middle facet (29.8%/26.8%, CI 25.7% to 33.9%) when compared to the posterior facet (12.5%/15.1%, CI 8.4% to 16.6%), p-value 〈 0.0001. The median difference between the measurements (Hodges-Lehman factor) was found to be 12.8% higher subluxation in the middle facet (CI 6.6 to 21.2%).We also found that for each 1% increase in the amount of posterior facet subluxation, a 1.7 times higher subluxation could be expected in the middle facet. Conclusion: This study is the first to compare measurements of the amount of subluxation of the posterior and middle facets of the subtalar joints as markers of peritalar subluxation in patients with AAFD. We found a positive and linear correlation between the measurements, with the middle facet subluxation being significantly more pronounced than the posterior facet by an average of almost 13%. Our results are consistent with the idea that the middle facet subluxation might represent an earlier sign of pronounced and progressing peritalar subluxation in patients with adult acquired flatfoot deformity. [Figure: see text]
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2874570-X
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  • 4
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0002-
    Abstract: Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Recent literature has established the middle facet of the subtalar joint as a reliable and accurate marker of pronounced peritalar subluxation (PTS) in Adult Acquired Flatfoot Deformity (AAFD) patients. The Foot and Ankle Offset (FAO) has also been accepted as a more complete and three-dimensional (3D) measurement of foot collapse and hindfoot valgus. To date, no assessment has been made regarding the relationship between the severity of the AAFD and the amount PTS measured at the middle facet. The objective of this study was to investigate the correlation between these variables. We hypothesized that direct positive linear correlation would be found, with significantly increased middle facet joint incongruence and subluxation in patients with more pronounced hindfoot valgus and foot collapse. Methods: In this IRB-approved retrospective comparative study, we included 76 feet (42 left, 35 right) with symptomatic AAFD who underwent standing weightbearing CT (WBCT) as standard baseline assessment of their foot deformity. One blinded fellowship-trained foot and ankle surgeon with more than 10 years of experience performed measurements using multiplanar reconstruction (MPR) WBCT images. Manual measurements of subluxation and incongruence of the middle facet were performed at the anteroposterior midpoint of the articular facet. Semiautomatic calculation of the FAO was performed after 3D coordinate harvesting of the weightbearing points of the first, fifth metatarsal and calcaneus as well as the center of the ankle. Correlation of FAO severity and subluxation/incongruence of the middle facet was assessed by Spearman’s correlation and bivariate analysis. Paired Wilcoxon was utilized to compare FAO values in congruent (0% subluxation), subluxated (1-99% subluxation) and dislocated middle facets. P-values 〈 0.05 were considered significant. Results: No significant direct correlation was observed between FAO and Middle Facet Incongruence angle (p=0.12). However, positive linear correlation was found between middle facet subluxation and FAO (Spearman’s 0.54, R2 0.29, p 〈 0.0001). The subluxation of the middle facet was found to increase by 3.5% for every one-point FAO increase (Middle Facet Subluxation (%) = 6.903202 + 3.5452074*Foot and Ankle Offset). Mean values and confidence intervals (CI) of FAO were significantly different depending on the congruency of the middle facet (p=0.0003): congruent, 5.2 (CI, 3.4 to 7.0), subluxated, 8.7 (CI, 6.8 to 9.0) and dislocated, 12.9 (CI, 9.8 to 15.9). Similarly, middle facet subluxation was also found to progressively and significantly increase when FAO values were staged from zero (normal alignment) to four (FAO 〉 20) (p 〈 0.0001). Conclusion: This study is the first to compare and correlate measurements regarding the amount of subluxation of middle facet with the severity of AAFD, when measured by the foot and ankle offset (FAO). We found a significant, positive and linear correlation between the amount of subluxation of the middle facet and FAO measurements. No correlation was found between the incongruence angle of the facet and FAO. Our results support the concept of using the subluxation of the middle facet of the subtalar joint as a key marker of early and progressive deformity in patients with AAFD.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 5
    Online Resource
    Online Resource
    SAGE Publications ; 2017
    In:  Foot & Ankle International Vol. 38, No. 10 ( 2017-10), p. 1160-1169
    In: Foot & Ankle International, SAGE Publications, Vol. 38, No. 10 ( 2017-10), p. 1160-1169
    Type of Medium: Online Resource
    ISSN: 1071-1007 , 1944-7876
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2129503-7
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  • 6
    In: Foot and Ankle Surgery, Elsevier BV, Vol. 21, No. 2 ( 2015-06), p. 77-85
    Type of Medium: Online Resource
    ISSN: 1268-7731
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2006229-1
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  • 7
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 8, No. 1 ( 2023-01)
    Abstract: Ankle Arthritis; Other Introduction/ Purpose: The orthopaedic field, including foot and ankle surgery, continues to rely on patient reported outcome measures (PROMs) as the cornerstone of research studies. Various questionnaires exist, each with their advantages and disadvantages. The Patient-Reported Outcomes Measurement Information System (PROMIS) has become increasingly popular due to its reliability, validity, and efficiency. This system has been tested against the Foot and Ankle Outcome Score (FAOS) for foot and ankle conditions, however little is known about its validity for patients with ankle arthritis undergoing total ankle arthroplasty (TAA). Additionally, its relationship to functional tests is unknown, which could reveal whether it could be used in lieu of these resource-intensive assessments. Therefore, we aimed to validate PROMIS against the FAOS and functional tests in TAA patients. Methods: This prospective cohort study included 102 patients (mean age: 63.5 years) who were diagnosed with ankle arthritis and underwent subsequent TAA. Preoperative PROMIS scores, FAOS, and functional tests including the 4 square test (4SST), timed up and go (TUG), and sit-to-stand (STS) were gathered and analyzed preoperatively. PROMIS physical function and pain interference domains were tested for reliability using Rasch partial credit models. Convergent validity between PROMIS physical function and pain interference, and FAOS function, daily living was evaluated using Spearman’s correlation coefficient. In addition, the relationship between the functional tests and all 6 PROMIS domains were evaluated using Spearman’s correlation coefficient. Results: Infit and outfit mean squares (MSQs) for PROMIS physical function ranged from 0.61 – 0.78, indicating a good fit in the Rasch model. Similarly, infit and outfit MSQs for PROMIS pain interference ranged from 0.77 – 0.8, also indicating a good fit. Separation reliability was 0.89 for physical function and 0.85 for pain interference, indicating good reliability to actual patient function and pain levels. PROMIS physical function demonstrated a moderate positive correlation with FAOS function, daily living (r=0.52) while pain interference demonstrated a moderate negative correlation (r=-0.52). PROMIS physical function demonstrated statistically significant weak negative correlations for all 3 functional tests (r=-0.19 for 4SST, r=-0.27 for TUG, r=-0.2 for STS) [Figure 1]. Conclusion: Our study revealed good reliability of PROMIS physical function and pain interference domains, with a moderate correlation to FAOS function, daily living. Additionally, we found weak correlations between PROMIS physical function and functional tests and no significant correlations between pain interference and functional tests. This indicates acceptable convergent validity to the FAOS but not to functional tests. Therefore, while PROMIS provides reliable and valid measures, it does not replace the need for functional tests, which should be pursued in conjunction to deliver a complete assessment of TAA patients.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 8
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0003-
    Abstract: Hindfoot; Ankle; Midfoot/Forefoot Introduction/Purpose: Multiple surgical techniques are used in the correction of Adult Acquired Flatfoot Deformity (AAFD). Assessment of the efficacy of a surgical treatment in the correction of the deformity is usually performed by clinical evaluation and conventional radiographic imaging. Weightbearing CT (WBCT) allows a more reliable and multiplanar evaluation of AAFD. The Foot and Ankle Offset (FAO) is a WBCT biometric semi-automatic measurement that gauges the relative positioning between the foot tripod and the center of the ankle joint. This study aimed to investigate the efficacy of surgical treatment in correcting AAFD, comparing preoperative and postoperative FAO measurements. We hypothesized that surgical treatment would provide significant correction of the deformity, centering the tripod of the foot underneath the ankle joint. Methods: In this prospective comparative study, 21 adult patients (22 feet) with flexible AAFD were included, mean age 55 (range, 23-81) years, 13 females and eight males. Patients underwent preoperative and postoperative standing WBCT examination. Three-dimensional coordinates (X, Y and Z planes) of the foot tripod (weightbearing point of the first and fifth metatarsals and calcaneal tuberosity) and center of the ankle (apex of the talar dome) were harvested by two independent and blinded observers. The FAO was automatically calculated from the harvested 3D coordinates by dedicated software. Data regarding the surgical technique used was recorded. Patient Reported Outcomes (PROs) were collected preoperatively and postoperatively at a mean follow-up of 22 (range, 8-36) months. Pre and postoperative FAO measurements were compared by paired T-tests. Multivariate analysis was used to assess the influence of surgical procedures in the amount of FAO correction. P-values of less than 0.05 were considered significant. Results: We found excellent intra (0.98) and interobserver reliability (0.96) for FAO measurements. The mean preoperative FAO was 10.4 (95% CI, 8.5 to 12.1). There was a significant correction of the deformity postoperatively (p 〈 0.0001), with a mean postoperative FAO of 1.4 (CI, -0.1 to 2.9), and mean improvement of 8.9 (95% CI, 6.6 to 11.2). Average increase in PROs was (p 〈 0.05): physical function (8; CI, 4 to 12), pain interference (10.3; CI, 4.8 to 15.9), pain intensity (5.3; CI, -10:20.6), mental health (4.2; CI, 0.2:8.2), physical health (4.3; CI, 0.9 to 9.8), and depression (10.4; CI, -0.6 to 21.4). The mean number of surgical procedures performed was 8 (range, 2-12). Spring ligament reconstruction was the only technique that influenced the amount of FAO correction (P 〈 0.001). Conclusion: To the author’s knowledge, this is the first study to assess the amount of surgical correction of AAFD using standing WBCT images and semiautomatic 3D measurements. We found that surgical treatment provided a significant and pronounced amount of correction in the FAO, with the foot tripod more centered underneath the ankle joint. We also found a significant improvement in the PROMIS after an average postoperative follow-up of 22 months. Among multiple different surgical procedures performed, reconstruction of the spring ligament was the only technique that significantly influenced the amount of FAO correction. Longer-term follow-up studies are needed. [Figure: see text]
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 9
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0003-
    Abstract: Basic Sciences/Biologics; Hindfoot; Sports Introduction/Purpose: Different animal models of Achilles tendinopathy have been proposed in the literature. They usually involve the induction of tendinopathic findings by either chemical stress (most commonly with one or more injections of collagenase, mimicking intrinsic factors) or mechanical stress (by repetitive exercise-induced stress with treadmill running exercises, simulating extrinsic risk factors). To date, no study has evaluated the combination of a mechanical trigger followed by collagenase injections, replicating the logical and sequential steps involved in the development the human pathology. Our goal was to develop this novel animal model of Achilles tendinopathy and to compare histological and functional findings with animals subjected to isolated mechanical or chemical stress, as well as to controls. Methods: Sixty-four Sprague-Dawley rats were divided into four groups (n=16): isolated treadmill running protocol (15o uphill running, 20meters/minute, 1hour/day, 3 weeks duration, weeks 2-4); isolated injections of collagenase (0.1mg each, 3 injections total, weeks 5-7); treadmill protocol (weeks 2-4) followed by three consecutive collagenase injections (weeks 5-7); and controls, no running and three injections of normal saline (weeks 5-7). Five animals from each group were sacrificed at weeks 8 and 10. Six animals by group were sacrificed at week 12. Gait analysis was performed at weeks one (after acclimation), five (following running protocol), eight (following injection protocol) and twelve (just before latest sacrifice time-point). Histological findings were assessed by the Movin Tendinopathy Score (eight parameters, scored from 0-3, total score 0-24), assessing collagen arrangement, structure, and stainability, cellularity, vascularity, nuclear rounding, hyalinization and presence of glycosaminoglycans. Gait parameters included stand and swing times, stride length, duty cycle and swing length. Results: After 8 weeks, significantly increased tendinopathic scores (p 〈 0.001) were found in animals subjected to collagenase injections (16, CI 13.1-18.9) and to running/collagenase (17.4, CI 14.4-20.3), when compared to controls (1.6, CI -1.3-4.50) and running (3, CI 0.1-5.9). Similarly, after 10 weeks significantly increased scores were found in the same groups, with slight severity regression: controls (1, CI -0.8-2.8), running (2.2, CI 0.4-4.0), collagenase (10, CI 8.2-11.8) and running/collagenase (17.6, CI 15.8- 19.4). After 12 weeks, collagenase group demonstrated reversion of the findings (3.3, CI 1.6-5.1), and wasn’t different than control (2.1, CI 0.4-3.9) and running groups (2.5, CI 0.3-4.7). However, significantly increased pathological findings were noted in the running/collagenase group (20.0, CI 18.2-21.8) consistent with chronic tendinopathic process. Gait analysis results presented in Figure1. Conclusion: When compared to other models of induced Achilles tendinopathy and to controls, the novel animal model induced by a mechanical trigger and sustained by chemical stress demonstrated progressively increased histological tendinopathic scores after 12 weeks. Findings observed after isolated mechanical or chemical stresses were temporary, not maintained at latest follow- up. Steps involved in tendinopathy development, as well as the observed histological results of the combined running/collagenase model, replicate better the findings of human chronic Achilles tendinopathy. Applications for this novel model are promising, potentially supporting a better understanding of early/late findings as well as treatment options for Achilles tendinopathy. [Figure: see text]
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2874570-X
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  • 10
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 7, No. 4 ( 2022-10), p. 2473011421S0092-
    Abstract: Midfoot/Forefoot; Basic Sciences/Biologics; Hindfoot Introduction/Purpose: A recent study published in Nature (Venkadesan et al.) demonstrated that coupling the transverse arch (TA) with the medial longitudinal arch (MLA) significantly increased midfoot intrinsic stiffness. The contribution of the TA is substantial, suggested as the evolutionary advancement providing the foot stiffness required for human bipedalism. Progressive collapsing foot deformity (PCFD) is a complex deformity ultimately resulting in loss of stiffness and collapse of the MLA. The novel understanding of the TA may play a key role in the pathogenesis of this deformity. The objectives of this study were to assess and compare the TA curvature in PCFD and controls and to evaluate its relationship with accepted PCFD measures. We hypothesized that the curvature of the TA will be decreased in PCFD. Methods: A retrospective review was conducted for 32 PCFD and 32 controls. Measurements were performed using weight- bearing CT (WBCT). A novel measurement, the transverse arch plantar (TAP) angle, was designed to directly measure the TA in both PCFD (Figure 1a) and controls (Figure 1b). TA curvature was calculated using the equation described by Venkadesan et al. (Figure 6) utilizing width, length (Figure 3a), 3rd metatarsal thickness (Figure 3b), and 4th metatarsal torsion (Figure 4a, 4b). Finally, uni- and multivariate analyses were performed to analyze the relationship between the TAP angle, Foot and Ankle Offset (FAO), peritalar subluxation, and measurements associated with PCFD classes: hindfoot moment arm (class A), talonavicular coverage angle (class B), Meary angle (class C), medial facet uncoverage angle (class D), and talar tilt (class E). Normality of different variables was assessed using the Shapiro-Wilk test. Two groups were compared using t-test for normal, and Mann-Whitney for non-normal variables. Results: Measurements of the TAP angle were found to be significantly higher in the PCFD group than the control group with a mean angle of 115.24° (SD 10.68) and 100.76° (SD 7.92) respectively (p 〈 0.001) (Figure 2).No significant difference was found in the calculated TA curvature between PCFD and controls with mean values of 17.84 (SD 4.41) and 18.18 (SD 3.68) respectively (p=0.741) (Figure 5).The univariate analysis performed showed a moderate positive correlation between the TAP angle and the FAO (ρ=0.58;r2=0.34;p 〈 0.001).The multivariate analyses showed, among the different PCFD class measurements and the TAP angle, only the middle facet uncoverage (β=0.08,p 〈 0.001) and hindfoot moment arm (β=0.32, p 〈 0.001) were associated with higher values of FAO, while only the Meary (β=0.49,p=0.004) and the talonavicular coverage angles were associated with higher values of peritalar subluxation (β=0.75,p 〈 0.001). Whereas, Meary's angle was the only predictive factor of higher TA collapse (β=0.55,p 〈 0.001). Conclusion: Our direct measurement showed a collapsed of the TA in PCFD. However, this did not appear to be a consequence of insufficient bone torsion, but rather some other etiology, possibly a soft tissue failure. Considering the implication of the TA among the different PCFD classes, it did not appear to play a significant role on the overall PCFD deformity. TA collapse seemed mainly influenced by Meary's angle, which assess the MLA. This further supports the idea behind TA and MLA coupling suggesting that when the TA is collapsed, the foot does not possess the required stiffness to maintain the MLA.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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