The Density-Weighted Foot Center Is Different to the Geometric Foot Center

Abstract

Category: Basic Sciences/Biologics; Hindfoot Introduction/Purpose: It has become a reality with the advent of weight bearing CT (WBCT) that weight bearing (WB) is a significant element to be considered when analyzing foot and ankle images. Some knowledge has begun to accumulate on the effect of WB on bone positioning, but the effect of WB on bone mineral density (BMD) distribution, apart from being a long for accepted truth since the works of Julius Wolff, could not until now be visualized other than on the biological level. Now, Hounsfield Units allow for bone density analysis on WBCT. The objective of the study was to compare the relative positions of the geometric foot center (GC) and the density-weighted foot center (DC). We hypothesized those to be different. Methods: Ethics approval was obtained. Thrity two feet from our WBCT database were retrospectively randomly selected (Curvebeam Pedcat, Hatfield PA, USA). Datasets were analyzed using Bonelogics software (Disior, Paragon 28, USA). Bone segmentation was performed to obtain all bone orientations and volumes excluding tibia and fibula and all phalanges. The data was computed to obtain the geometric centers (from bone surface coordinates), which were considered as reference and were given a value of 0. Therefore density-weighted centers (from all bone data including density) were calculated. The difference between the two centers represented the shift which was assessed along the sagittal axis (anterior shift), transversal axis (lateral shift) and craniocaudal axis (upward shift). Statistical analysis was conducted using STATA package. Results: The mean age and Body Mass Index of the cohort were 57.2 ± 9.6 years and 22.2 ± 2.8 kg/m2, respectively. The 3D displacement vector between GC and DC had a norm of 10.01 mm. We found that DC was significantly shifted anteriorly by 8.9 ± 0.3 mm (range, 5.6 mm to 13.4 mm), medially by 0.4 ± 0.8 mm (range, -1.3 mm to 0.3 mm) and upwardly by 4.2 ± 0.14 mm (range, 2.8 mm to 5.9 mm) (p < 0.001 in all cases). Conclusion: Our hypothesis was confirmed: the geometric and weighed foot centers were different. DC was more anteriorly and slightly medially situated. Both centers were situated at the interface between the talus and cuboid. The more anterior position may be explained by the fact that human foot is responsible for anteriorly orientated longitudinal movement on average. We deem that BMD is a significant dimension in WBCT datasets that cannot be ignored in the development of new measurement tools that are not currently standardized. Alignment based purely on bone outer shape without considering BMD may not be representative of their true biomechanical state.