Radiographs Of Feet Research Articles

Outcomes of cobalt-chrome 3D-printed total talus replacement with and without combined total ankle replacement

BackgroundCollapse of the talus and peri-talar arthritis pose treatment challenges due to the anatomy and location of the talus as a keystone of the foot and ankle. Custom 3D-printed total talus replacement (TTR) and combined total ankle total talus replacement (TATTR) have emerged as treatment options for these pathologies. However, the safety and efficacy of these implants is unknown due to the limited number of cases and short follow-up durations. MethodsThis was a retrospective study to assess surgical outcomes of patients who underwent a TTR and TATTR with or without subtalar fusion. Patient demographics, intraoperative parameters, device related surgical and non-surgical events, imaging and clinical evaluations, and patient reported outcome (PRO) measures were compiled. ResultsA total of 38 patients received a custom 3D-printed implant with mean follow-up time of 22.1 (range: 12–45) months. In this cohort, 7 (18.4 %) required secondary surgery and 3 (7.9 %) required implant removal. Multivariate logistic regression revealed that patient diagnosis of depression was a significant predictor of secondary surgery with an OR 17.50 (p = 0.037). Significant postoperative improvements were observed in the talocalcaneal height (p = 0.005) and talar declination angle (p = 0.013) for the TATTR group. VAS and PROMIS pain interference (PI) scores demonstrated an initial significant improvement in pain, but this improvement did not maintain significance at most recent follow-up. However, there was a significant increase in the PROMIS physical function (PF) scores (p = 0.037) at most recent follow-up. ConclusionThese results demonstrate that TTR and TATTR provide significant improvement in post-operative radiographic foot and ankle alignment and physical function at the two-year timepoint. PRO findings suggest that patients are more active after surgery. Surgeons considering proceeding with either of these procedures should counsel patients about pain and functional outcomes as well as realistic expectations in patients with depression. Level of evidenceLevel 3

Distribution of Sesamoid Bones in the Foot and Hand Radiographs; A Descriptive Cross-Sectional Study in a Tertiary Care Center in Nepal

Objective: The aim of this study was to present data about the prevalence and distribution of sesamoid bones of the hands and feet in Nepalese population by using radiographs, to determine the number of the sesamoid bones of the foot and hand, commonest site of occurrence and to correlate the findings between gender and age. Methodology: This prospective quantitative study was performed in the Department of Radiology and Imaging, TUTH. The radiographs of foot and hand were reviewed to evaluate the presence or absence of sesamoid bones and patient demographics were also noted. Data collection was done for a period of three months and random probability sampling method was used. Results: This study resulted that in foot radiographs, the most common sites of sesamoid bones was first metatarsophalangeal joint (1st MTPJ) where two sesamoid bones were found, whereas single sesamoid bone was found in other sites. The percentage of sesamoid bones in first interphalangeal joint (1st IPJ), second metatarsophalangeal joint (2nd MTPJ), third metatarsophalangeal joint (3rd MTPJ), fourth metatarsophalangeal joint (4th MTPJ) and fifth metatarsophalangeal joint (5th MTPJ) were 7.9%, 15.4%, 0 %, 0.4%, and 26.7% respectively. The number of sesamoid bones ranged from 2- 5 in single foot with frequency of occurrence of 2 bones being highest (58.3%). The percentage of sesamoid bones in foot was found to be relatively higher in female than male. In the analysis of hand radiographs, the most common sites of sesamoid bones was 1st MCPJ ( single sesamoid bone in 80.33% and a pair of sesamoid bones in 19.67% ) .The percentage of sesamoid bones in 1st IPJ, 2nd MCPJ, 3rd MCPJ, 4th MCPJ and 5th MCPJ were 37.33%, 58.67% ,5.33% , 5.33% and 59.33% respectively. The number of sesamoid bones ranged from 1 - 6 in single hand with frequency of occurrence of 3 bones being higher (32%). The percentage of sesamoid bones in hand was relatively higher in male than female. Conclusion: The distribution and frequency of sesamoid bones differ according to sites, gender and age. This study improves the knowledge on distribution of sesamoid bones of the foot and hand and also provides anatomical data that could help clinicians in diagnosis and management of various sesamoid bone disorders in patients who present with pain and discomfort in the foot and hand.

Fixation in Missed Lisfranc Injuries: Should This Be Attempted?

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: The Lisfranc injuries are not so uncommon. However, subtle injuries are often either missed or misdiagnosed as “mid foot sprain” during initial assessment. Missed lisfranc injuries causes various problems like chronic pain, fallen medial arch, functional loss etc. The decision regarding whether to fix such missed or chronic injuries or to do an arthrodesis is still a topic of debate. So the purpose of this study was to evaluate the outcomes of delayed fixation of missed lisfranc injuries. Methods: A total of 10 patients with missed lisfranc injuries (more than 6 weeks after injury) were included in the study. Most of the patients had previous history of subtle, low energy injuries to their foot which was treated conservatively. All the patients preoperatively underwent weight bearing radiographs of foot and distance between lateral border of medial cuneiform and medial border of 2nd metatarsal base were measured for degree of displacement. Patients were treated with an open reduction and internal fixation as opposed to arthrodesis. Outcomes were assessed using VAS score, American Orthopaedic Foot & Ankle Society (AOFAS) Mid foot score, post operative radiographic evaluation and return to work time. Out of 10 patients, 70% were female and 30% were male. The average time interval between injury and surgery was 9.6 + 2.50 weeks. The mean age was 41.5 and mean follow up duration was 33.6 + 12.98 months. Results: The average degree of displacement between lateral border of medial cuneiform and medial border of 2nd metatarsal base was 5.14 mm. At final follow up no patients had radiographic signs of a late diastasis at the Lisfranc joint. The pre operative VAS score improved from 7.5 + 1 to 1.6 + 0.69 post operatively. One patient had developed arthritis at 1st and 2nd TMT joints but did not had any symptoms. The average AOFAS mid foot score pre & post operatively was 37.6 + 10.8 & 84.2 + 6.54 respectively, with two patients having excellent outcome, six patients having good outcome and two patients having fair outcome. At final follow up all patients could perform their ADL & recreational activities independently. Conclusion: Subtle, low velocity missed lisfranc injuries can be well managed with open reduction and internal fixation. In our series, delayed fixation resulted in decreased pain scores and a fair to good functional outcome and returned to their pre injury work.

The Controversial Definition of Normal Toe Alignment.

"Normal" and "abnormal" are frequently used in surgical planning and to evaluate surgical results of the forefoot. However, there is no objectifiable value of metatarsophalangeal angles (MTPAs) 2-5 in the dorsoplantar (DP) view with which to objectively evaluate lesser toe alignment. We aimed to determine which angles are considered to be "normal" by orthopedic surgeons and radiologists. Thirty anonymized radiographs of feet were submitted twice in randomized order to determine the respective MTPAs 2-5. After six weeks, the anonymized radiographs and photographs of the same feet without apparent affiliation were presented again. The terms "normal," "borderline normal," and "abnormal" were assigned by the observers. Viewers considered MTP-2 alignment from 0° to -20° to be normal, and below -30° abnormal; MTP-3, 0° to -15° to be normal and below -30° abnormal; MTP-4, 0° to -10° normal and below -20° abnormal. Between 5° valgus and 15° varus was the range of MTP-5 recognized as normal. High intra-observer but low interobserver reliability with overall low correlation of clinical and radiographic aspects was observed. The assessment of the terms "normal" or "abnormal" are subject to a high degree of variation. Therefore, these terms should be used cautiously.

Lisfranc Injury Diagnosis: What Is the Diagnostic Reliability of New Radiographic Signs Using Three-dimensional CT?

Up to one-third of Lisfranc injuries (an injury affecting the normal stability, alignment, and congruency of the tarsometatarsal joints) are misdiagnosed. Delayed diagnosis and improper treatment may lead to long-term, irreversible sequela and functional disability. Recently, the employment of three-dimensional (3D) CT demonstrated higher diagnostic reliability, but there is limited evidence on this, and radiologic features of Lisfranc injuries when using this diagnostic modality are not well described. What is the diagnostic performance of several novel radiographic signs on 3D CT when evaluating for Lisfranc injury, namely the Mercedes sign, the peeking metatarsal sign, and the peeking cuneiform sign, and what is the interobserver and intraobserver reliability of those diagnostic signs? In this retrospective, diagnostic study, video clips of 3D CT reconstructions of 52 feet with intraoperatively confirmed Lisfranc injuries and 50 asymptomatic feet with a normal appearance of the tarsometatarsal joints, as ascertained by a subspecialty-trained foot and ankle surgeon and a musculoskeletal radiologist, were analyzed by two foot and ankle specialists and three orthopaedic residents twice each, with a washout period of 2 weeks. Among the 52 patients with intraoperative evidence of Lisfranc injury, there were 27 male patients and 25 female patients, with a median (IQR) age of 40 years (23 to 58); among the 50 controls, there were 36 male and 14 female patients, with a median age of 38 years (IQR 33 to 49). For each video clip, the presence of all three radiographic signs was documented (each sign was rated in a binary yes/no fashion). Before the evaluations, all observers underwent a short training session by the head of the foot and ankle department. Later, these reading were used to assess for the sensitivity, specificity, and area under the receiver operating characteristic curve in terms of Lisfranc diagnosis against the gold standard of intraoperative testing of tarsometatarsal joint stability. Intraoperatively, the congruency and stability of the second tarsometatarsal joint had been evaluated by direct visualization and by the insertion of a probe into the joint between the base of the second metatarsus and the medial cuneiform and twisting the probe to assess for stability. The individuals evaluating the video clips were unaware of the surgically obtained diagnosis at the time they performed their evaluations. All 3D radiographic signs that were examined had excellent diagnostic reliability in terms of sensitivity and specificity, ranging from 92% to 97% and from 92% to 93%, respectively. When assessing the association between the suggested 3D radiographic signs and Lisfranc injury diagnosis as a function of the area under the receiver operating characteristic curve, the Mercedes sign demonstrated a higher area under the curve than the other signs did (0.91 versus 0.87 versus 0.8; p < 0.001). The mean intraobserver and interobserver reliability (kappa) values were excellent for all 3D radiographic signs that were evaluated. The proposed radiographic findings demonstrated excellent diagnostic performance and were repeatable within and among observers. Three-dimensional CT radiographic signs could function as a valuable diagnostic tool for the evaluation and initial screening for Lisfranc injury in the acute injury phase because obtaining AP bilateral standing radiographs of the foot is often impractical in the acute setting. Further research and comparison with AP weightbearing radiographs of the bilateral feet may be warranted. Level III, diagnostic study.

Hoof Unevenness in Juvenile Quarter Horses During First 6 Months of Training

The role of hoof morphology is increasingly recognized as a factor associated with lameness incidence in performance horses. The primary objective was to evaluate effect of training initiation on hoof unevenness in Quarter Horses (n = 42; 29 2-year-olds, 13 3-year-olds) over 6-months (m) in training (m0, m2, m4, and m6). Horses were objectively assessed for lameness (inertial sensor system) and photographs and radiographs of feet were taken. Hoof measurements were taken (palmar/plantar angles, frog base width/length, toe length/angle, heel length/angle, heel/foot width, wall height/angle), and analyzed with regards to laterality. Front and hindfoot pairs were determined even if toe angles were within 1.5°. Statistical analyses were performed (Fisher's exact test, mixed-model linear regression, P < .05). There were no differences in distal phalanx palmar/plantar angle between lame/nonlame forelimbs (P = .54) or hindlimbs (P = .20). Unevenness between front feet was seen in toe angle m6 (P < .001), heel length m6 (P = .01) and heel angle over time (P = .006). Unevenness between hind feet was seen at m6 in toe angle (P < .001), heel length (P = .009) and heel angle (P = .02). Lameness incidence did not differ between even and uneven footed horses in forelimbs (P = .64) or hindlimbs (P = .09). In uneven feet, there was no difference in lameness between high versus low foot in forelimbs (P = .34) or hindlimbs (P = .29). Limitations include lack of control group not entering training, lack of consistency in timing data collection to previous trimming, and small sample size. In summary, differences in foot measurements and laterality were noted over time following training initiation in juvenile Western performance horses.

Radiographic foot alignment and morphological features of deltoid ligament in pediatric patients with medial osteochondral lesions of the talus.

The cause of osteochondral lesions of the talus (OLT) in patients without a history of trauma remains unclear, and almost all nontraumatic lesions appear to involve the medial talar dome. This study aimed to investigate the relationship between foot alignment, deltoid morphology, and medial OLT in pediatric patients. In total, 28 patients (31 feet) with medial OLT (17 boys, 11 girls, mean age: 14.9 years), and 50 patients without OLT (50 feet, 31 boys, 19 girls, mean age: 14.5 years) were included in this study. The OLT patients were subdivided into traumatic and nontraumatic groups. Radiographic parameters of the foot arch were measured on weight-bearing lateral images. The extent of the OLT was measured on computed tomographic images. The ratio of deep deltoid attachment length of the talus to talar height was examined as deltoid ligament position index (DPI) on coronal magnetic resonance imaging. Nontraumatic medial lesions were frequently observed in pediatric patients (54.8%) compared to traumatic lesions. The depression of the foot arch was commonly identified in pediatric patients with resistant medial lesions. The lesion size was moderately correlated with DPI (rho = 0.48; P = 0.0086). The attachment of the deep deltoid ligament to the medial talar dome was located more proximally in nontraumatic lesions than in traumatic lesions and the control group. Our findings suggest that a combination of foot alignment and the anatomic variations in the attachment of the deep deltoid ligament contributes to the incidence of nontraumatic medial OLT in the pediatric population. Level of evidence: level IV.

Biometric radiographic features between foot lesions and long toe under-run heel in donkeys

AbstractThe present study aimed to document the relationship between biometric foot measurements and different radiographic lesions in a group of donkeys' feet with long toe under-run heel. The common radiographic foot lesions were pedal osteitis complex in 26 (86.6%) and navicular bone reaction in 8 (26.7%). Osteophyte reaction was identified at proximal phalanx in 8 (26.7%) and middle phalanx in 10 (33.3%). Pastern and coffin joints osteoarthritis were found in 4 (13.3%) and 9 (30%) respectively. Palmar soft tissue calcification and eminence of 2nd phalanx were reported in 5 (16.6%) and 1 (3.3%) respectively. The dorsal hoof wall angle (DHWA) was positive significantly correlated with the axis of the distal phalanx, distal phalanx and proximal palmar cortex angles, the heel angle, and distal phalanx solar border angle. The increased dorsal hoof wall length (DHWL) was positive strongly correlated with dorsal coronary band height, medial wall length, lateral wall length, lateral coronary band distance, medial coronary band distance, lateral distal phalanx to bottom distance, and medial distal phalanx to bottom distance. The dorsal hoof wall and heel angles reflected increased stress on the hoof capsule, distal interphalangeal joint, navicular bone, and palmar soft tissue structures. The low heel, the distal phalanx solar border angle and under development of the palmar section of the hoof indicated distal phalanx was slightly slippage dorsally, increased tension on the DDFT, navicular bone, and pedal osteitis complex in long toe under-run heels. This study demonstrated a relationship between biometric foot measurements and the presence of radiographic foot lesions detected in long toe under-run heel in donkeys.

The diagnostic dilemma of congenital foot deformity in pediatrics: could adding ultrasound be problem solving?

BackgroundFoot deformity is one of the most common congenital musculoskeletal anomalies in the pediatric age group. Accurate diagnosis can be sometimes impossible to be established clinically. In the assessment of foot abnormalities, radiology plays a crucial role. Lack of ossification of the tarsal bones renders plain radiographs of the foot as of little diagnostic value in this age group. MRI apart from its cost requires anesthesia and sedation. In contrast, ultrasonography allows for the imaging of cartilaginous structures. As a result, newborn foot abnormalities can be thoroughly assessed. The whole anatomy of the foot is evaluated using several scanning views. Additional planes may be needed to show the pathologic features of a specific deformity. The purpose of this study was to demonstrate the additive value of ultrasound to plain radiographs in the assessment of foot deformities in the pediatric age group.ResultsThis case–control study was performed on sixty children, 30 of which were patients admitted from the pediatric orthopedic clinic, presenting with foot deformity, after being examined clinically. Antero-posterior and lateral radiographs of foot, tibiocalcaneal, antero-posterior talocalcaneal, and lateral talocalcaneal angles were measured. Sonographic examination was done in different projections of both feet, while the patient is lying supine with dynamic sonography. The sonographic parameters measured were as follows: medial malleolar–navicular distance and medial soft tissue thickness on medial projection, calcaneocuboid distance on lateral projection, talonavicular relation on dorsal projection, and tibiocalcaneal distance on posterior projection. There was a statistically significant difference between patients and controls in the medial malleolar–navicular distance and medial soft tissue thickness measured on the medial view, the calcaneocuboid distance recorded on the lateral view, and the tibiocalcaneal distance measured on the posterior view.ConclusionsUltrasonography has a growing and useful role as a complementary imaging modality in the evaluation and follow-up of pediatric patients with foot deformity.

Identification of Radiographic Foot Osteoarthritis: Sensitivity of Views and Features Using the La Trobe Radiographic Atlas.

To compare the sensitivity of alternative case finding approaches for the identification of foot osteoarthritis (OA) based on the La Trobe radiographic atlas. This was a cross-sectional study of 533 adults age ≥50 years with foot pain in the past year. Weightbearing dorsoplantar (DP) and lateral radiographs were taken of both feet. The La Trobe radiographic atlas was used to document the presence of osteophytes (OPs) and joint space narrowing (JSN). The prevalence of OA in each joint was documented using both views and features in combination (as recommended in the original atlas), and by using a single view (DP or lateral only) and a single feature (OP or JSN only). Compared to the recommended case definition based on OPs and JSN using both views, a DP-only view identified between 15% and 77% of OA cases, while a lateral-only view identified between 28% and 97% of OA cases. Compared to the recommended case definition of using both features, using only OPs identified between 46% and 94% of OA cases, while using only JSN identified between 19% and 76% of OA cases. Applying the La Trobe radiographic atlas but using only 1 radiograph view (DP or lateral) or 1 feature (OP or JSN) in isolation misses a substantial number of OA cases, and the sensitivity of these approaches varies considerably between different foot joints. These findings indicate that, where possible, the atlas should be administered according to the original description to avoid under-ascertainment of radiographic foot OA.

The Prevalence of Accessory Ossicles, Sesamoid Bones, and Biphalangism of the Foot and Ankle: A Radiographic Study.

Background:Accessory ossicles, sesamoid bones, and biphalangism of toes are the most common developmental variations of the foot. These bones may be associated with painful syndromes; however, their clinical importance is not well understood because the reported prevalence varies widely. Therefore, we aimed to investigate these variants in Turkish subjects.Methods:A total of 1651 foot radiographs were retrospectively assessed. Radiographs of feet were examined regarding the prevalence, sex, and bilaterality of accessory ossicles, sesamoid bones, and biphalangism in Turkish subjects.Results:Accessory ossicles (26.1%) and sesamoid bones (8%) were detected. The most common accessory ossicles were os trigonum (9.8%), accessory navicular bone (7.9%), and os peroneum (5.8%). Also, we detected os supratalare (0.48%), os calcanei secundarium (0.42%) os subfibulare (0.42%), os supranaviculare (0.36%), os vesalianum (0.30%), os subtibiale (0.24%), os intermetatarseum (0.12%), and os subcalcis (0.12%). We observed bipartite hallux sesamoid in 1.8% and interphalangeal sesamoid bone of the hallux in 0.7% of radiographs. Incidences of metatarsophalangeal sesamoid bones were found as 0.6%, 0.06%, 0.6%, and 5.8% in the second, third, fourth, and fifth digit, respectively. We observed biphalangeal toe in 0.5%, 1.7%, 3.5%, and 37.6% in the second, third, fourth, and fifth toe, respectively.Conclusion:This study is the first detailed report on the incidence of the most common variants of the foot and ankle in a wide-ranging patients’ series in Turkish subjects. Our study’s findings will contribute to reducing misdiagnosis.Clinical Relevance:The results of this study may provide anatomical data that could help clinicians in the diagnosis and management of disorders that present with pain and discomfort in the feet. Knowledge of these variants is important to prevent misinterpreting them as fractures.

Denosumab did not improve computerized tomography erosion scores when added to intensive urate-lowering therapy in gout: Results from a pilot randomized controlled trial

Background/PurposeDisordered osteoclast activity has been implicated in the pathogenesis of gouty bone erosion. We sought to determine if the addition of denosumab (a monoclonal antibody targeting the receptor activator of nuclear factor kappa-B ligand - RANKL) to intensive urate-lowering therapy (ULT) improves gouty bone erosion. MethodsOpen-label, parallel-group pilot randomized controlled trial in which 20 participants with gout with at least one confirmed conventional radiographic foot bone erosion were assigned in a 1:1 allocation to receive denosumab (60 mg subcutaneous every 6 months) added to intensive ULT (serum urate ≤5 mg/dL or 300 µmol/L at the time of randomization and continued for the duration of the study), or intensive ULT alone. The primary outcome was the change in the bilateral foot and ankle computed tomography (CT) bone erosion score from baseline to 12 months, assessed by an experienced musculoskeletal radiologist blinded to study assignment. Secondary outcomes included change in serum C-terminal telopeptide (CTX), and patient reported outcomes of pain and function. ResultsAlthough serum CTX declined markedly in the denosumab/ULT group compared with the ULT alone group, there was no interval change in CT erosion score in either the denosumab/ULT or ULT alone group after one year of follow-up. Other secondary outcomes did not differ between groups. There were two severe adverse events: One patient developed atrial fibrillation (on denosumab/ULT) and another atrial flutter (on ULT alone). ConclusionsIn this pilot study, denosumab did not offer additional benefit to intensive urate lowering therapy for gouty bone erosion.

English

BACKGROUND Foot problems are a leading cause of hospitalization for patients having diabetes mellitus all over the world. Foot ulcers in diabetes precede 85 % of nontraumatic lower-extremity amputations. Fifteen percent develop foot ulcers during their lifetime. Individuals who develop foot ulcers have a decreased health-related quality of life and consume a lot of healthcare resources. Foot abnormalities is a frequently missed diagnosis and a focus in this area of medical education has never been optimal despite its frequency of presentation. In this study, we wanted to determine clinical and radiographic foot abnormalities in diabetic patients. METHODS A cross-sectional study was carried out on 180 type 2 diabetic patients diagnosed as per ADA definition of diabetes, they were categorized into three groups, the first consisted of 60 diabetic patients without neuropathy or foot ulcers, the second had 60 diabetic patients with neuropathy and the third had 60 diabetic patients with both neuropathy and foot ulcer. Based on the clinical examination of the foot and foot X-ray oblique and lateral view of the affected feet along with other relevant investigations were obtained and analysed using descriptive and inferential statistical analysis. RESULTS We observed that poor glycaemic control and duration of diabetes were important risk factors for foot complications in diabetic patients which were statistically significant. Among patients with only diabetes, 3.3 % had HbA1c less than 6, 35 % had HbA1c between 6 - 9 and 61.7 % with HbA1c of more than 9. Among the patients with diabetes and neuropathy, 1.7 % of people had Hba1c of less than 6, 20 % with Hba1c between 6 - 9 and 78.3 % with Hba1c of more than 9. In patients who had diabetes and neuropathy with foot ulcers, 6.7 % had HbA1c of less than 6, among the same cohort 8.3 % had HbA1c between 6 - 9 and 85 % had HbA1c above 9. The prevalence of various radiological abnormalities of the foot was more common in diabetic patients with both neuropathy and foot ulceration (group lll) (83.3 %). The most common abnormality as observed from our study was Osteopenia with osteoporotic changes seen in 36.7 % of Group III patients VS 16.7 % of Group II (patients with diabetes and neuropathy ) and only in 10 % of Group I patients (patients with diabetes without any complications). Vascular calcifications were observed in 26.7 % VS 16.7 % VS 6.7 % in Group III, Group II, Group I respectively. Periosteal reactions were also more common in Group III patients (6.7 %). Subluxation of 2nd, 3rd, 4th, and 5th metatarsals was observed only in 3.3 % of Group III patients. CONCLUSIONS Diabetic foot is one of the most devastating complications of diabetes. Preventing the diabetic foot should be the first priority. This can be achieved by identifying the high-risk individuals with the above said risk factors by proper clinical examination and use of foot X-ray. KEY WORDS Diabetic Foot, Foot Problems, Foot Infections.

Risk Factors for Persistent Pain Requiring Surgical Treatment in Adult Symptomatic Accessory Navicular.

Identifying the risk factors for persistent pain despite proper conservative treatment in adult symptomatic accessory navicular may reduce the need for surgical treatment. The aim of this study was to identify any such risk factors. Cohort study. University hospital foot and ankle clinic. A retrospective review of 313 patients who presented with adult symptomatic accessory navicular was performed. Potential risk factors were identified via medical records and foot radiographs. The possible risk factors included age, gender, body mass index, smoking status, occurrence/cause of symptoms, occupation, type of accessory navicular, and radiographic foot parameters. Predictors that relate to persistent pain requiring surgical treatment in adult accessory navicular were analyzed using logistic regression analysis. Of the 313 patients included, 30 (9.6%) underwent surgical treatment due to failure of conservative treatment. The odds of needing surgical treatment decreased by 0.96 per year of age at symptom onset (P = 0.030), but those odds were 8.52 times higher in patients who had a type IIB accessory navicular (P = 0.001). Other variables did not reach statistical significance. Younger age at symptom onset and type IIB were the risk factors for persistent pain requiring surgical treatment in adult symptomatic accessory navicular.

P61 Trajectories of foot pain severity over seven years and relationship to potential prognostic factors: the clinical assessment study of the foot

Abstract Background Foot pain is common and disabling in older adults however little is known about its course. The objective of this study was to identify foot pain trajectories over seven years and examine the associations between progressive symptom trajectories and potential prognostic factors. Methods All adults aged ≥50 years registered with four general practices in North Staffordshire, UK were mailed a health survey at baseline. Those reporting foot pain in the previous 12 months were invited to attend a research clinic that included a standardised interview, physical examination, and plain radiographs of the feet. Follow-up was by repeated postal surveys at 18 months, three years, 54 months, and seven years. Trajectories of repeated measures of foot pain severity in the previous month (10-point numerical rating scale) were identified using Latent Class Growth Analysis (LCGA). Logistic regression was undertaken to explore the relationship between these trajectories and both person-level and foot-level prognostic factors adjusted for covariates (age, gender, and body mass index). Results Of 560 adults with foot pain attending baseline research clinics, 425 (76%) provided data at baseline and ≥two follow-up time-points and were included in the analysis. The optimum LGCA model for foot pain severity was a 4-class model with the following trajectories: mild improving pain (n = 109, 26%); moderate improving pain (n = 179, 42%); moderate persistent pain (n = 122, 29%); severe persistent pain (n = 15, 4%). Compared with individuals with mild/moderate improving pain trajectories, those with moderate/severe persistent pain trajectories over 7 years did not differ significantly by age, sex, foot posture or radiographic foot OA phenotype at baseline, but were more likely to be overweight/obese. After adjustment for covariates, these less favourable long-term trajectories were associated with lower socioeconomic position, poorer physical and mental health, catastrophising, greater foot-specific functional limitation (Manchester Foot Pain and Disability Index), and self-reported hallux valgus at baseline (Table 1). Conclusion Over a 7-year period, one-third of individuals had persistent moderate to severe pain. Targeting interventions to modifiable prognostic factors such as obesity and hallux valgus may have the potential to improve long-term outcomes in people with foot pain. Disclosures M. Marshall None. M. Blagojevic-Bucknall None. T. Rathod-Mistry None. M.J. Thomas None. J.J. Edwards Other; JJE is part of The Keele Academic General Practice which has received funding from Bristol-Myers Squibb to develop and evaluate a quality improvement tool in anticoagulation. G. Peat None. H.B. Menz None. E. Roddy None.

Identification of radiographic foot osteoarthritis: are both dorsoplantar and lateral x-rays necessary?

Purpose: The La Trobe radiographic atlas of foot osteoarthritis (OA), which was developed in 2009 to standardise the assessment of foot OA, incorporates observations of osteophytes (OP) and joint space narrowing (JSN) from dorsoplantar (DP) and lateral plain film x-rays. In some clinical and research contexts, two radiographic views may not be available, and this has the potential to affect the proportion of foot OA cases identified using this tool. Therefore, the purpose of this study was to compare the sensitivity of alternative case-finding approaches based on restricted x-ray views (DP or lateral only) or features (OP or JSN only).

P51. Associations in the sagittal plane: no evidence that foot radiographs predict sagittal alignment or degeneration of the spine

BACKGROUND CONTEXT 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 (FA 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. OUTCOME MEASURES Sagittal parameters were measured on lateral of lumbar spine radiographic views and foot and ankle parameters were analyzed on anteroposterior (AP), lateral, and mortise of ankle as well as AP, lateral, and oblique of foot. METHODS Bonferroni correction was performed to account multiple statistical analyses, which resulted in the level of significance set to p 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). CONCLUSIONS 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 between their F&A and lumbar spine symptoms by citing that there is a lack of known association between radiographic findings used to evaluate these two regions of the body. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Foot and Ankle Radiographic Parameters in Korean Adults Vary by Sex and Age

Although many radiographic measurements of the foot and ankle have been used, reference values for normal functional groups are rarely reported. These can change according to sex and age; therefore, this study aimed to: (1) determine reference values for radiographic foot and ankle angles in an asymptomatic healthy Korean population, and (2) compare differences in the measurements according to sex and age. A total of 200 healthy volunteers were recruited, including 100 young adults (50 males, 50 females) aged 20 to 35 years, and 100 older adults (50 males, 50 females) aged 60 to 69 years. Weightbearing ankle anteroposterior views, talar tilt, and tibiotalar angles were measured. On the weightbearing foot anteroposterior views, the hallux valgus, hallux interphalangeal, and talo-first metatarsal angles were measured. On the weightbearing lateral foot views, the calcaneal pitch, lateral talo-calcaneal, lateral talo-first metatarsal, and lateral calcaneo-first metatarsal angles were measured. Values were stratified by sex and age, and statistically compared. The hallux valgus, calcaneal pitch, and lateral calcaneo-first metatarsal angles were affected by both sex and age; the hallux interphalangeal angle was affected by age and the lateral talo-first metatarsal angle by sex. We presented reference values for foot and ankle radiographic measurements in a healthy Korean population; several radiographic indices varied significantly by sex or age, which were grossly similar to previous studies based on white race. The study data can serve as a basis for evaluation of foot and ankle disorders.

Impact of different classification criteria on the prevalence of radiographic foot osteoarthritis: data from the Chingford 1000 women study

Impact of different classification criteria on the prevalence of radiographic foot osteoarthritis: data from the Chingford 1000 women study

Symphalangism on Radiographs of Foot - A Cross Sectional Study

Symphalangism on Radiographs of Foot - A Cross Sectional Study