Associations in the Sagittal Plane: No Evidence that Foot Radiographs Predict Sagittal Alignment or Degeneration of the Spine

Abstract

Category:Ankle, Ankle Arthritis, Hindfoot, Midfoot/ForefootIntroduction/Purpose:The interaction between hip pathology and spinopelvic alignment is a current subject of interest in orthopedics with a number of recently performed studies. However, little is known regarding the interaction between foot & ankle (F&A) pathology and spinopelvic alignment, despite common complaints from patients such as back pain potentially caused by an outturning foot. The purpose of this study is to test for associations between F&A pathology and spinopelvic alignment and degeneration.Methods:A retrospective cohort study was conducted involving consecutive patients who presented to both F&A and spine surgeons within the same practice. Inclusion criteria required that each patient have the following radiographic views while in a weight bearing, standing position: lateral of lumbar spine; anteroposterior (AP), lateral, and mortise of ankle; AP, lateral, and oblique of foot. Patients were excluded from analysis if there was radiographic evidence of previous surgical instrumentation in the spine, ankle, or foot. Bonferroni correction was performed to account multiple statistical analyses, which resulted in the level of significance set to p<0.001.Results:A total of 55 patients met inclusion criteria. There were no associations found between F&A pathology and spinopelvic alignment/degeneration (p>0.001 for each; Table 1).Conclusion:A common patient concern is that a foot condition may be contributing to low back pain through altered gait and postural dynamics. With the numbers available, we were unable to demonstrate statistical associations between F&A radiographic findings and spinopelvic alignment or degeneration. Orthopaedic surgeons can address patients’ concerns about the relationship