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  • 1
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    Side-to-Side Difference of Metatarsal Rotation in Normal Individuals
    SAGE Publications ; 2022
    In:  Foot & Ankle International Vol. 43, No. 6 ( 2022-06), p. 790-795
    Details
    In: Foot & Ankle International, SAGE Publications, Vol. 43, No. 6 ( 2022-06), p. 790-795
    Abstract: A previous study defined the normal first metatarsal pronation angle (MPA) as 〈 16 degrees and normal α angle as 〈 18 degrees. The primary purpose of this study was to assess the side-to-side variation in first metatarsal pronation between feet in normal individuals. Methods: MPA and α angles were measured on standardized coronal weightbearing computed tomography slices. Paired t tests were used to test significance of mean side-to-side differences in a population of 63 normal, asymptomatic individuals. Results: The mean side-to-side difference in first metatarsal pronation was 4.3 degrees (95% CI 3.3, 5.2 degrees) for MPA and 4.9 degrees (95% CI 3.8, 6.0 degrees) for α angle. The normative range for side-to-side difference was calculated as 12 degrees for MPA and 14 degrees for α angle, as defined by 2 SDs from the mean. Conclusion: In a cohort of normal patients, the mean difference in first metatarsal pronation between sides was approximately 4 to 5 degrees based on MPA and α angle. However, considerable variation in differences was observed. These findings may be considered when assessing first metatarsal pronation using population-based values as it may influence thresholds for identifying pathology in an individual.
    Type of Medium: Online Resource
    ISSN: 1071-1007 , 1944-7876
    URL: Article
    DOI: 10.1177/10711007221079610
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2129503-7
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  • 2
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    2D Manual vs 3D Automated Assessment of Alignment in Normal and Charcot-Marie-Tooth Cavovarus Feet Using Weightbearing CT
    SAGE Publications ; 2022
    In:  Foot & Ankle International Vol. 43, No. 7 ( 2022-07), p. 973-982
    Details
    In: Foot & Ankle International, SAGE Publications, Vol. 43, No. 7 ( 2022-07), p. 973-982
    Abstract: The complex deformities in cavovarus feet may be difficult to assess and understand. Weightbearing computed tomography (WBCT) is increasingly used in evaluating complex deformities. However, the bone axes may be difficult to calculate in the setting of severe deformity. Computer-assisted 3D axis calculation is a novel approach that may allow for more accurate assessment of foot alignment or deformity. This study aimed to assess differences in measurements done manually on 2D slices of WBCT vs 3D computer models in normal and cavus feet. Methods: We retrospectively analyzed WBCT scans from 16 normal and 16 cavus feet in patients with Charcot-Marie-Tooth disease. Six measurements were assessed: talar–first metatarsal angle (axial plane), forefoot arch angle (coronal plane), and Meary angle, calcaneal pitch, and cuneiform and navicular to floor distances (sagittal plane). 2D measurements were performed manually and 3D measurements were performed using specialized software (Bonelogic, DISIOR). Bland-Altman plots and linear regression were used to analyze differences. Results: There were no significant biases in measured variables in normal feet. In the cavovarus group, automated assessment calculated increased sagittal plane deformity (fixed bias 7.31 degrees for Meary angle, 2.39 degrees for calcaneal pitch) and less axial plane deformity (fixed bias 10.61 degrees for axial talar–first metatarsal angle). The latter also demonstrated proportional bias indicating greater discrepancy with increasing adduction. Conclusion: Measurements were comparable in normal feet suggesting automated techniques can reliably assess the alignment of bony axes. However, automated calculations show greater sagittal and less axial deformity in cavovarus feet than measured by manual techniques. This discrepancy may relate to rotational deformity seen in cavovarus feet, which may not be easily assessed manually. 3D automated measurements may therefore play a role in better assessing and classifying the cavovarus foot, which may ultimately inform treatment algorithms. Level of Evidence: Level III, retrospective comparative study.
    Type of Medium: Online Resource
    ISSN: 1071-1007 , 1944-7876
    URL: Article
    DOI: 10.1177/10711007221084308
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2129503-7
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  • 3
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    Three-Dimensional Weightbearing Assessment of the First Ray in Hallux Valgus: A Case-Control Study
    SAGE Publications ; 2019
    In:  Foot & Ankle Orthopaedics Vol. 4, No. 4 ( 2019-10-01), p. 2473011419S0005-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 4, No. 4 ( 2019-10-01), p. 2473011419S0005-
    Abstract: Bunion Introduction/Purpose: Coronal plane rotational deformity of the first ray has been implicated with the developmental pathologic process of hallux valgus (HV). Weight Bearing CT (WBCT) is an imaging technology that can support the assessment of this complex three-dimensional (3D) deformity. The objective of the study was to analyze the 3D architecture of the first ray in patients with HV when compared to controls using WBCT images and a 3D biometric algorithm analyzing the deformity in all three planes. We hypothesized that WBCT would confirm the rotational deformity in HV patients, and that the 3D algorithm would demonstrate increased specificity and sensitivity for the pathology when compared to traditional two-dimensional (2D) HV measurements such as the 1-2 intermetatarsal angle. Methods: Retrospective case-control study, ethics committee approved. Twenty-one feet of patients with clinically symptomatic HV and 20 feet of asymptomatic controls were included. Exclusion criteria applied were previous trauma or surgery affecting first ray or forefoot morphology. All patients were assessed using WBCT. First ray 3D coordinates (x, y, z) were harvested including: center-points of the heads and bases of the first and second metatarsals, center-point of the medial and lateral sesamoids, distal condyles of the proximal phalanx (PP) of the first toe, as well as the medial and lateral borders of the first metatarsal head and diaphysis. The 2D measurements (dorsoplantar 1-2 intermetatarsal (IMA) and metatarsophalangeal (MPA) angles) were obtained using digitally reconstructed radiographs (DRR). The Sesamoid Rotation Angle (SRA) was measured in the coronal plane. Using these coordinates, all 2D, 3D axes, distances, angulations and 3D biometric for HV (HV-3DB) could be calculated. Results: Mean ages were respectively 62.2y in the HV group and 48.8y in the control group (p 〈 0.05). In 2D, the mean IMA and MPA for HV/controls were respectively 14.9/9.3 (p 〈 0.001) and 30.1/13.1 (p 〈 0.001). The SRA were respectively 29.1/7.1 (p 〈 0.001). We found an almost perfect positive correlation between P1 rotation and sesamoid rotation, good correlation between IMA, MPA and SRA angles. There was poor correlation between pronation angles of the 1st phalanx and the 1st metatarsal. The 3D biometric algorithm combining IMA, MPA and SRA had a sensitivity of 95% and a specificity of 95.2% for the diagnosis of HV, compared to 90%/85.6% for the IMA and 90%/90.5% for the SRA. Conclusion: This original study confirmed our hypotheses. Weight Bearing CT efficiently analyzed the 3D architecture of the 1st ray in HV patients compared to asymptomatic controls. We concur with previous findings described in the literature concerning increased pronation of the 1st ray in HV. A novel biometric for HV using a specific multidimensional algorithm which combined IMA, HVA and SRA in a single 3D measurement, demonstrated increased sensitivity and specificity compared to the conventional 2D 1-2 intermetatarsal angle for the diagnosis of HV.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011419S00050
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2874570-X
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  • 4
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    3D Imaging for Hindfoot Alignment: A Comparative Study between MRI and Weight Bearing CT
    SAGE Publications ; 2020
    In:  Foot & Ankle Orthopaedics Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0024-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0024-
    Abstract: Hindfoot; Other Introduction/Purpose: Hindfoot malalignment is a common finding in multiple foot and ankle pathologies. In clinical practice, it is usually quantified through traditional weight bearing radiographs or, more recently, through cone beam weight bearing CT (CB- WBCT), which overcomes issues related to two-dimensional imaging. Interestingly, a few studies have suggested that hindfoot alignment can also be accurately assessed using non-weight bearing magnetic resonance imaging (MRI). The purpose of this study was to compare measurements of hindfoot alignment on non-weight bearing ankle MRI and CB-WBCT and to establish if there was any correlation. Methods: In this Level III retrospective comparative study, a database review identified 51 feet in 47 patients (27 males, 20 females; mean age of 45 (range 13-79)) which had both CB-WBCT and MRI scans on the same day as part of standard care at our specialist tertiary referral Foot and Ankle Unit. Hindfoot alignment was assessed by independent Consultant Musculoskeletal specialists. The foot ankle offset (FAO), calcaneal offset (CO) and hindfoot alignment angle (HA) were assessed on CB-WBCT using dedicated software. The tibiocalcaneal angle (TCA) and calcaneofibular ligament angle (CFLA) were assessed on non-weight bearing MRI. Pearson correlation was used to evaluate the correlation between these measurements. Results: We found a statistically significant positive correlation between TCA on non-weight bearing MRI and each measurement on CB-WBCT (Pearson correlation for TCA and FAO: 0.42, p=0.003; for TCA and CO: 0.46, p=0.001; and for TCA and HA: 0.40, p=0.005).We also demonstrated a moderate-to-low negative but significant correlation between CFLA and CO (Pearson correlation: -0.35; p=0.03). Conversely, the negative correlation between CFL and FAO (Pearson correlation: -0.29; p=0.07) and CFL with HA (Pearson correlation: -0.26; p=0.11) did not reach statistical significance. Conclusion: Weight bearing three-dimensional imaging has shown high degrees of accuracy and reproducibility for hindfoot alignment. The significant correlation between TCA on non-weight bearing MRI and hindfoot alignment measurements on CB- WBCT suggests that TCA should be reported during routine ankle MRI in order to put into context some of the soft-tissue findings. The CFLA shows a less significant negative correlation.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011420S00243
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 5
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    The Position and Morphology of the Peroneus Longus Tubercle in Hallux Valgus: A Weight-Bearing CT Assessment
    SAGE Publications ; 2022
    In:  Foot & Ankle Orthopaedics Vol. 7, No. 4 ( 2022-10)
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 7, No. 4 ( 2022-10)
    Abstract: Bunion; Midfoot/Forefoot Introduction/Purpose: The peroneus longus is one of the main dynamic stabilisers of the first ray acting through its primary insertion at the first metatarsal base and has the theoretical possibility to be defunctioned in hallux valgus (HV). In this study, our primary objective was to report and compare the position and morphology of the peroneus longus tubercle (PLT) in feet with and without HV, using weightbearing CT (WBCT). Methods: A retrospective analysis of WBCT scans was completed using 40 feet in 23 patients. Feet were divided into two equal groups - the normal, 'non-hallux valgus' (non-HV) group and the 'HV' group (Mean age 60.45 and 60.60 respectively). The morphology and position of the PLT was assessed between groups. The intermetatarsal angle (IMA) and metatarsal pronation angle (MPA) were assessed. We also introduce and have assessed the novel measurements of tubercle-to-floor distance (T-F distance), the bisecting angle of the PLT, tubercle-to-metatarsals angle (T-MT angle) as well as the metatarsal cross-sectional area. Results: Between the non-HV group and the HV group, significant differences were found in the T-F distance (mean 26.7mm and 23.35mm respectively, p = .001), illustrating a lower medial column in HV. There was a moderate correlation between IMA and T- F distance (r = -.475, p 〈 .001) confirming depression of the first ray with increasing IMA. The bisecting angle was lower in the HV group as compared to non-HV (mean 61.65 degrees and 66.60 degrees respectively, p=0.017), demonstrating pronation of the PLT in relation to the floor in the HV. We found a significant difference in T-MT angle between the HV and non-HV groups (mean 31.85 degrees and 35.85 degrees respectively, p=0.041) and a strong correlation between the T-MT angle and bisecting angle (r = .817, p 〈 .001) suggesting the pronation occurred in the first metatarsal to a larger degree than the remainder of the forefoot. Conclusion: In this study we have demonstrated a difference in the position of the PLT between HV and non-HV individuals, with a pronated PLT noted in individuals with HV.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011421S00775
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2874570-X
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  • 6
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    Online Resource
    Reliability of Hindfoot Alignment Using Weightbearing CT Semi Automatic Software : an Analysis of 135 Feet
    SAGE Publications ; 2017
    In:  Foot & Ankle Orthopaedics Vol. 2, No. 3 ( 2017-09-01), p. 2473011417S0000-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 2, No. 3 ( 2017-09-01), p. 2473011417S0000-
    Abstract: Ankle, Hindfoot, Imaging Introduction/Purpose: Hindfoot Alignment (HA) on 2D radiographs presents anatomical and operator-related bias. In this study, weightbearing CT (WBCT) was used to measure HA using a semi-automatic software which gives HA as a value of Foot Ankle Offset (FAO) after selecting four landmarks (weight bearing points of first and fifth Metatarsals, Calcaneus and center of the ankle joint). We assessed the intra and interobserver reproducibility and the distribution of FAO values in a series of datasets from clinically normal, varus and valgus cases. We hypothesized that reproducibility would be excellent. Furthermore, FAO in normals should have a Gaussian distribution and be significantly different to the varus and valgus groups. Methods: In this level 3, retrospective comparative study, WBCT (PedCAT ®, CurveBeam LLC, Warrington, PA, USA) datasets were obtained from an existing database. The 135 feet were assessed by a senior foot and ankle surgeon as normal, varus or valgus (57, 38 and 40 respectively). Two surgeon investigators (one senior and one trainee) independently analyzed each case using a semi-automatic HA measurement tool (TALAS ™, CurveBeam LLC, Warrington, PA, USA). A third, independent investigator conducted the statistical analysis using Stata® Software. Results: The overall intraoberver and interobserver reliability were 0.99 ± 0.002 and 0.97 ± 0.02 respectively. In normal cases, mean value for FAO was 2.38% ± 2.96, whereas in varus and valgus cases mean was -11.67% ± 6.90 and 11.47% ± 5.79, respectively (p 〈 0.001). The normal population had a Gaussian distribution with a Kolmogorov-Smirnov test 〉 0.8 Conclusion: This study reports excellent reliability and discriminative power of a semi-automatic 3D measurement tool for Hindfoot Alignment in WBCT.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011417S000058
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2874570-X
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  • 7
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    Online Resource
    Subtalar Arthroereisis as an Adjunct Procedure Improves Forefoot Abduction in Stage IIb Adult- Acquired Flatfoot Deformity
    SAGE Publications ; 2020
    In:  Foot & Ankle Orthopaedics Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0013-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0013-
    Abstract: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Our aims were: (i) to determine whether subtalar arthroereisis (STA) as adjunct procedure improved radiographic correction of stage IIb adult acquired flexible flatfoot deformity (AAFD); (ii) to assess the STA-related complication rate. Methods: A retrospective analysis of 22 feet (21 patients) diagnosed with stage IIb AAFD treated by medialising calcaneal osteotomy (MCO), flexor digitorum longus (FDL) transfer, spring ligament (SL) repair with or without Cotton osteotomy and with or without STA in a single institution was carried out. Seven measurements were recorded on pre and postoperative (minimum 24 weeks) radiographs by two observers and repeated twice by one. Inter and intraobserver reliability was assessed. The association of demographic (gender, side, age, BMI) and surgical variables (Cotton, STA) with radiographic change was tested with univariate analysis followed by a multivariable regression model. Results: Excellent inter and intraobserver reliability was demonstrated for all measurements (ICC range, 0.75-0.99). Multivariable regression showed that STA was the only predictor of change in talo-navicular coverage angle (TNCA) (R2=0.31; p=0.03) and in calcaneo-fifth metatarsal angle (CFMA) (R2=0.40; p=0.02) on dorsoplantar view. STA was associated to a greater change in TNCA by 10.1 degrees and in CFMA by 5 degrees. Four patients out of 12 STA complained of sinus tarsi pain after STA, and removal of the implant resolved symptoms in 3 of them. Conclusion: In this series, STA as an adjunct procedure to MCO, FDL transfer, SL repair in the treatment of stage IIb AAFD led to improvement in correction of forefoot abduction. STA-related complication and removal rates were 33%.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011420S00130
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 8
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    Ankle Joint Bone Density Distribution Correlates with Overall 3-Dimensional Foot and Ankle Alignment
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of Bone and Joint Surgery
    Details
    In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health)
    Abstract: Altered stress distribution in the lower limb may impact bone mineral density (BMD) in the ankle bones. The purpose of the present study was to evaluate the spatial distribution of BMD with use of weight-bearing cone-beam computed tomography (WBCT). Our hypothesis was that BMD distribution would be even in normal hindfeet, increased medially in varus hindfeet, and increased laterally in valgus hindfeet. Methods: In this study, 27 normally aligned hindfeet were retrospectively compared with 27 valgus and 27 varus-aligned hindfeet. Age (p = 0.967), body mass index (p = 0.669), sex (p = 0.820), and side (p = 0.708) were similar in the 3 groups. Hindfoot alignment was quantified on the basis of WBCT data sets with use of multiple measurements. BMD was calculated with use of the mean Hounsfield unit (HU) value as a surrogate. The HU medial-to-lateral ratio (HUR), calculated from tibial and talar medial and lateral half-volumes, was the primary outcome of the study. Results: The 3 groups significantly differed (p 〈 0.001) in terms of tibial HUR (median, 0.91 [interquartile range (IQR), 0.75 to 0.98] in valgus hindfeet, 1 [IQR, 0.94 to 1.05] in normal hindfeet, and 1.04 [IQR, 0.99 to 1.1] in varus hindfeet) and talar HUR (0.74 [IQR, 0.50 to 0.80] in valgus hindfeet, 0.82 [IQR, 0.76 to 0.87] in normal hindfeet, and 0.92 [IQR, 0.86 to 1.05] in varus hindfeet). Linear regression showed that all hindfoot measurements significantly correlated with tibial and talar HUR (p 〈 0.001 for all). The mean HU values for normally-aligned hindfeet were 495.2 ± 110 (medial tibia), 495.6 ± 108.1 (lateral tibia), 368.9 ± 80.3 (medial talus), 448.2 ± 90.6 (lateral talus), and 686.7 ± 120.4 (fibula). The mean HU value for each compartment was not significantly different across groups. Conclusions: Hindfoot alignment and medial-to-lateral BMD distribution were correlated. In varus hindfeet, an increased HU medial-to-lateral ratio was consistent with a greater medial bone density in the tibia and talus as compared with the lateral parts of these bones. In valgus hindfeet, a decreased ratio suggested greater bone density in the lateral as compared with the medial parts of both the tibia and the talus. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0021-9355 , 1535-1386
    URL: Article
    DOI: 10.2106/JBJS.23.00180
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 9
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    Online Resource
    Use of bone marrow derived stem cells in trauma and orthopaedics: A review of current concepts
    Baishideng Publishing Group Inc. ; 2015
    In:  World Journal of Orthopedics Vol. 6, No. 6 ( 2015), p. 462-
    Details
    In: World Journal of Orthopedics, Baishideng Publishing Group Inc., Vol. 6, No. 6 ( 2015), p. 462-
    Type of Medium: Online Resource
    ISSN: 2218-5836
    URL: Article
    DOI: 10.5312/wjo.v6.i6.462
    Language: English
    Publisher: Baishideng Publishing Group Inc.
    Publication Date: 2015
    detail.hit.zdb_id: 2649712-8
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  • 10
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    The dowel technique for first metatarso-phalangeal joint arthrodesis in revision surgery with bone loss
    Elsevier BV ; 2018
    In:  Foot and Ankle Surgery Vol. 24, No. 3 ( 2018-06), p. 224-228
    Details
    In: Foot and Ankle Surgery, Elsevier BV, Vol. 24, No. 3 ( 2018-06), p. 224-228
    Type of Medium: Online Resource
    ISSN: 1268-7731
    URL: Article
    DOI: 10.1016/j.fas.2017.02.009
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2006229-1
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