Tibial Anterior Surface Angle Research Articles

Relations of ankle alignment and MRI findings of ankle osteoarthritis

Category: Ankle Arthritis Introduction/Purpose: MRI is gaining attention as a tool for examining the severity of osteoarthritis (OA) over X-ray findings. However, there are few reports on the relationship between MRI and X-ray findings in ankle joints. We assessed the combination of ankle joint alignment and MRI to find the factor to predict MRI findings from X-ray findings in OA. Methods: Of the 341 patients who had a diagnosis of ankle OA in our hospital from May 2009 to August 2015, we assessed 46 feet of 45 patients who underwent MRI. We determined ankle joint alignment by measuring tibial anterior surface (TAS) angle, and tibial lateral surface (TLS) angle on X-ray, and determined the areas of Bone Marrow Edema (BME) appearing on STIR, by partitioning 22 areas for talocrural, tarocalcaneal, Chopart joint. In the statistics analysis, we divided into two groups with and without BME, and we compared TAS angle and TLS angle. Moreover, for predicting the occurrence of BME, we divided the disease group into 2 groups, training set and validation set. We then verified the validity of the results by measuring cut-off value of TAS angle and TLS angle from ROC curve, an area which had statistically significant difference. Results: TAS angles or TLS angles were significantly lower in the group which showed BME at the anterior medial part of the tibia canopy and medial malleolus joint surface. From the ROC curve of the training set, the cut-off value (TAS angle of 82 degrees or less and TLS angle of 76 degrees or less) was obtained. Applying the obtained cut-off value to the validation set, it was possible to predict the occurrence of BME on the medial malleolus joint surface (sensitivity 71%, specificity 67%). Conclusion: Association with BME and clinical symptoms as well as disease prognosis has been reported in the OA area, so predicting the appearance of BME can be a useful index for prescribing a treatment plan. It was suggested that the appearance of BME could be predicted from X-ray findings because it was related to ankle alignment and MRI. It is possible that these findings could be used as a new diagnostic tool to estimate disease severity in the future.

Changes in the Ankle Joint and Hindfoot Alignment Following Varus Deformity Correction of the Knee with Total Knee Arthroplasty

Category: Ankle, Hindfoot Introduction/Purpose: Compensatory changes occur in the ankle joint and the subtalar joint of the hindfoot to maintain neutral alignment in coronal plane when varus or valgus deformity is present in the knee joint. The purpose of this study is (1) to analyze how the ankle and hindfoot joint compensate the changes in mechanical axis that occur with varus deformity of the knee, (2) to analyze the changes in ankle and hindfoot joint alignment when mechanical axis alignment is corrected by correction of varus deformity of the knee with total knee arthroplasty (TKA), and (3) to radiographically evaluate the degree of changes in ankle and hindfoot joint alignment according to the degree of varus deformity correction. Methods: 375 knees that underwent TKA with varus deformity were prospectively studied. The degree of varus deformity of the knee joint was measured in standing long leg anteroposterior views taken before and 6 months after TKA. The angle between the ground surface and the superior dome of the talus, and the talar tilt were measured in standing ankle joint anteroposterior views taken before and 6 months after TKA. Preoperative tibial anterior surface angle and tibial lateral surface angle were measured. Hindfoot alignment was evaluated in hindfoot alignment views taken before and 6 months after operation by measuring the heel ratio, the heel angle, and the heel distance. These measurements were used to analyze the change in ankle joint and hindfoot alignment between before and 6 months after varus deformity correction. The relationship between the degree of varus knee correction and the change in ankle joint and hindfoot alignment was also analyzed. Results: The mean mechanical angle of the knee changed from varus 10.6±5.1° before operation to varus 0.1±3.2° after operation, which was statistically significant (P<0.001). The mean correction angle was 10.6±4.6°. Before operation, the mean tibial anterior surface angle was 89.9±3.1° and the mean tibial lateral surface angle was 81.5±2.9°. Talar tilt changed significantly from 0.3±2.0° to 0.0±1.6°, implying a varus change of the ankle joint (P=0.002). All of the evaluated hindfoot alignment parameters demonstrated a significant varus change (P<0.001), as the heel ratio changed from 0.2±0.2 preoperatively to 0.3±0.2 postoperatively (P<0.001), the heel angle changed from 11.4±7.0° preoperatively to 5.0±7.4°postoperatively (P<0.001), and the heel distance changed from 10.5±6.6 mm preoperatively to 6.4±6.4 mm postoperatively (P<0.000). Conclusion: Varus knee deformity tended to be associated with valgus deformity of the ankle joint and hindfoot alignment. Alignment in the ankle joint and the hindfoot both changed to a varus trend after correction of varus deformity of the knee. Such changes in ankle joint and hindfoot alignment are considered to be due to the compensatory changes following alterations in lower limb alignment. Therefore, it is necessary to perform a meticulous examination of the ankle joint as well as the knee joint and consider subsequent alteration of ankle joint and hindfoot alignment before surgical correction of knee joint alignment.

Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement

Category: Ankle Introduction/Purpose: A key for success in total ankle replacement is a balanced ankle joint. If the tibial component is misaligned, the ligamentous structures, the malleoli and the tendons may be overused, which, may lead to pain and impairment during gait. A misaligned tibial component can be revised using a corrective bone resection and re-insertion of a new component or using a corrective osteotomy of the distal tibia above the stable implant. The aim of this study was to review a series of patients, in whom a corrective supramalleolar osteotomy was performed to realign a misaligned tibial component in total ankle replacement. Methods: Twenty-two patients (nine male; 13 female; mean age, 62.6 years; range, 44.7 – 80.0) were treated with a supramalleolar osteotomy to correct a painful dysbalanced ankle, following a varus implanted tibial component. Following radiological and clinical outcomes were recorded preoperatively and at the follow-up examination within the first 24 months: the tibial anterior surface angle (TAS), the tibial lateral surface angle (TLS), patient’s pain measured with the Visual Analogue Scale (VAS), the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score, range of motion (ROM) of the ankle and patient’s satisfaction. Furthermore, postoperative complications were reviewed. Results: The TAS changed on average from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively (p < 0.0001), the AOFAS score increased from 46 ± 14 to 66 ± 16 points (p < .0001) and the VAS pain score decreased from 5.8 ± 1.9 to 3.3 ± 2.4 (p < .001). No statistical difference was found in the TLS and the range of motion. The osteotomy healed in 19 patients (86%), re-osteosynthesis was successful in the remaining three patients. In one of these three patients, a chronic infection of the ankle joint led to a below-knee amputation. Fifteen patients (68%) were (very) satisfied, four (18%) moderately satisfied and three (14 %) patients were not satisfied with the obtained postoperative result. Conclusion: The supramalleolar osteotomy was found to be an efficient alternative to correct the misaligned tibial component in total ankle replacement. Pain could be successfully addressed in the majority of the patients. The treatment of a malpositioned, well anchored tibial component with a supramalleolar osteotomy, instead of exchanging the tibial component, allows preservation of the bone stock. However, non-union should be mentioned as a possible complication of this surgery. Nonetheless, this method might be a feasible treatment option, especially for younger patients.

Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement.

Persistent pain despite a total ankle replacement is not uncommon. A main source of pain may be an insufficiently balanced ankle. An alternative to the revision of the existing arthroplasty is the use of a corrective osteotomy of the distal tibia, above the stable implant. This strictly extraarticular procedure preserves the integrity of the replaced joint. The aim of this study was to review a series of patients in whom a corrective supramalleolar osteotomy was performed to realign a varus misaligned tibial component in total ankle replacement. We hypothesized that the supramalleolar osteotomy would correct the malpositioned tibial component, resulting in pain relief and improvement of function. Twenty-two patients (9 male, 13 female; mean age, 62.6 years; range, 44.7-80) were treated with a supramalleolar osteotomy to correct a painful ankle with a varus malpositioned tibial component. Prospectively recorded radiologic and clinical outcome data as well as complications and reoperations were analyzed. The tibial anterior surface angle significantly changed from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively ( P < .0001), the American Orthopaedic Foot & Ankle Society hindfoot score significantly increased from 46 ± 14 to 66 ± 16 points ( P < .0001) and the patient's pain score measured with the visual analog scale significantly decreased from 5.8 ± 1.9 to 3.3 ± 2.4 ( P < .001). No statistical difference was found in the tibial lateral surface angle and the range of motion of the ankle when comparing the preoperative to the postoperative measurements. The osteotomy healed in all but 3 patients on first attempt. Fifteen patients (68%) were (very) satisfied, 4 moderately satisfied, and 3 patients were not satisfied with the result. The supramalleolar osteotomy was found to be a reliable treatment option for correcting the varus misaligned tibial component in a painful replaced ankle. However, nonunion (14%) should be mentioned as a possible complication of this surgery. Nonetheless, as a strictly extraarticular procedure, it did not compromise function of the previously replaced ankle, and it was shown to relieve pain without having to have revised a well-fixed ankle arthroplasty. Level IV, case series.

Realignment Surgery for Malunited Ankle Fracture.

To investigate the characteristics and the results of realignment surgery for the treatment of malunited ankle fracture. Thirty-three patients with malunited fractures of the ankle who underwent reconstructive surgery at our hospital from January 2010 to January 2014 were reviewed. The tibial anterior surface angle (TAS), the tibiotalar tilt angle (TTA), the malleolar angle (MA), and the tibial lateral surface angle (TLS) were measured. Clinical assessment was performed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analogue scale (VAS) scores, and the osteoarthritis stage was determined radiographically with the modified Takakura classification system. The Wilcoxon matched-pairs test was used to analyze the difference between the preoperative and the postoperative data. The mean follow-up was 36 months (range, 20-60 months). The mean age at the time of realignment surgery was 37.1 years (range, 18-62 years). Compared with preoperation, the TAS at the last follow-up showed a significant increase (88.50° ± 4.47° vs. 90.80° ± 3.49°, P = 0.0035); similar results were observed in TTA (1.62° ± 1.66° vs. 0.83° ± 0.90°, P < 0.01) and MA (82.30° ± 8.03° vs. 78.70° ± 4.76°, P = 0.005). At the last follow-up, the mean AOFAS score was significantly increased compared with the score at preoperation (44.5 ± 13.7 vs. 78.0 ± 8.9, P < 0.01). Significant differences in VAS scores were found at the last follow-up (6.76 ± 1.03 vs. 2.03 ± 1.21, P < 0.01). There was no significant difference in the Takakura grade between the preoperation and the last follow-up. One patient had increased talar tilt postsurgery; the postoperative talar tilt angle of this patient was 20°. One patient had progressive ankle osteoarthritis, and was treated by ankle joint distraction. Realignment surgery for a malunited ankle fracture can reduce pain, improve function, and delay ankle arthrodesis or total ankle replacement. Postoperative large talar tilt and advanced stages of ankle arthritis are the risk factors for the surgery.

체중부하 상태의 족관절 검사시 양측 족관절 동시 검사와 편측 족관절 검사의 방사선학적 비교

This study was performed to analyze the results of radiologic parameters compared both leg weight bearing position to single leg weight bearing position in ankle osteoarthritis. Between January 2016 and June 2016, 25 patients (50 ankles) who visited our Hospital to treat ankle pain. In radiographic assessment, We masured tibial anterior surface angle(TAS), tibial medial malleolar angle(TMM), talar tilting angle(TT), joint space width(JSW), tibiotalar joint space, fibulotalar joint space of ankle as radiologic parameters. On the right leg of the both leg weight bearing position, TAS was 87.24°, TT was 6.44°, TMM was 26.76°, fibulotalar joint space was 0.98mm. Right leg of the single leg weight bearing position, TAS was 88.93°, TT was 2.41°, TMM was 19.77°, fibulotalar joint space was 1.6mm. And then, on the left leg of the both leg weight bearing position, TAS was 87.25°, TT was 5.71°, TMM was 23.92°, fibulotalar joint space was 1.22 mm and left leg of the single weight bearing position, TAS was 88.75, TT was 3.19°, TMM 21.45°, fibulotalar joint space was 1.22 mm. There are unsimilarity between measure values of TAS and tibiotalar joint space. As the result of test of weight bearing ankle study, it would be more exact to examine to measure one side in the first time rather than both to conclude on accurate measurement.

Supramalleolar osteotomy with fibular osteotomy in treatment of varus ankle arthritis

Objective To evaluate the functional and radiological outcomes of supramalleolar osteotomy (SMOT) with fibular osteotomy for mid-staged varus ankle arthritis. Methods From April 2009 to April 2014, data of twenty-two patients with mid-staged varus ankle osteoarthritis who were treated with SMOT combined with fibular osteotomy and were followed up at least one yearwere retrospectively analyzed. There were 5 males and 17 females with mean age of 52.4 years (range, 37-71 years). According to modified Takakura ankle osteoarthritis stage, there were 5 cases in stage II, 12 in stage IIIa and 5 stage in IIIb. The American orthopedic foot and ankle society (AOFAS) ankle-hind score, Maryland foot score and Ankle Osteoarthritis Scale (AOS) were used for pre-and postoperative functional evaluation, as well as the range of motion (ROM) of ankle joint on sagittal plane. The tibial anterior surface angle (TAS), talar tilt (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) were evaluated pre-and postoperatively. Results The mean follow-up time was 36.6 (range, 17-55) months. Two cases had delay union. One case with postoperative pain and dysfunction was treated by ankle fusion. All of the osteotomy sites reached bony union with a mean time of 3.9 months (range, 3-8 months). The mean AOFAS score and Maryland score and AOS pain and function scores were improved significantly; the mean AOFAS score increased 31.7±12.5 points, the mean Maryland score increased 22.1±11.5 points, and the mean AOS pain and functional score reduced 16.1±7.4 and 15.6±6.9 respectively. Thirteen cases (62%) had improved on modified Takakura stages, 6 from stage II/III to stage I, 6 from stage III to stage II, and 1 from stage IIIb to stage IIIa. The ROM on sagittal plane increased from 32.8°±5.3° preoperatively to 35.7°±5.9° postoperatively.. For radiological evaluation, all the parameters were improved except TLS; the TAS reached a mean improvement of 7.2°±2.8°, the TT with a mean improvement of 4.4°±3.6°, the TC with a mean improvement of 9.8°±3.5°, the TLS with a mean improvement of 0.7°±1.2°. Conclusion SMOT combined with fibular osteotomy is promising with substantial functional improvement and malalignment correction for varus ankle arthritis; and is helpful even for those cases with large talar tilt angle. However, this procedure has no obvious improvement effect on the ROM of sagittal plane of ankle joint. Key words: Ankle joint; Osteoarthritis; Fibula; Osteotomy

Correlation Between the Talar Tilt Angle and Hindfoot Varus in Medial Ankle OA

Category: Ankle Arthritis Introduction/Purpose: Radiographically medial ankle osteoarthritis shows different features according to talar tilt which is known to an important determining factor in low tibial osteotomy surgery. However, little is known about the reason of this presentation. We hypothesized that the talar tilt angle and degree of hind foot varus might be correlated. Methods: We reviewed radiographs of 184 patients diagnosed with medial ankle osteoarthritis between May 2006 and February 2015. A total of 126 ankles in 97 patients diagnosed as Takakura stage 1–3b medial ankle osteoarthritis, were reviewed. We measured tibio-talar angle, talar tilt angle, tibial-anterior surface angle, and hindfoot alignment angle We divided the ankles into 4 groups according to tibio-talar angle by 10 degrees, and each group was further divided into 2 subgroups based on median talar tilt angle. We analyzed the correlation between talar tilt and hindfoot alignment angle in each group. We analyzed the differences in the hind foot alignment between the subgroups. Ankle radiographs of selected patients were measured by two observers to determine the interobserver reliability. One of the observers evaluated all radiographs twice to determine the intraobserver reliability. Results: The tibiotalar angle was strongly correlated with the talar tilt angle (r=−0.845), while there was no correlation between tibio-talar angle and hindfoot alignment angle(r=-0.595). Among the groups, tibio-talar angle of 70-80 showed a significantly different hindfoot alignment between the 2 subgroups (p=0.0187). In the rest groups, there was no significant difference between tibio-talar and hindfoot alignment angle. The interobserver and intraobserver reliability for all radiographic measurements was good to excellent Conclusion: We could find out a definite correlation between talar tilt and hindfoot alignment angle in certain degree of varus ankle OA, and no correlation between tibio-talar angle and hindfoot alignment, which might have a clincal relevance in determining the method of osteotomy surgery.

Treatment of Varus Ankle Osteoarthritis and Instability With a Novel Mortise-Plasty Osteotomy Procedure

Although joint-preserving surgery for intermediate ankle osteoarthritis has been reported to be effective, failures of supramalleolar osteotomy and plafond-plasty can occur because of persistent malalignment of the distal tibia and incongruent ankle mortise. We introduce a novel opening wedge distal tibial osteotomy procedure (mortise-plasty) with rigid plate fixation combined with synthetic bone wedges. We performed 27 mortise-plasties in 25 patients with varus ankle osteoarthritis and instability. Six males (24%) and 19 females (76%), with a mean age of 63 (range 28 to 79) years, were followed up for a mean of 27.3 (range 14 to 45) months. The mean preoperative visual analog scale score, American Orthopaedic Foot and Ankle Society score, and Takakura ankle scale score were 7.4 (range 5.4 to 10), 58.7 (range 18 to 84), and 55.9 (range 29 to 88), respectively. These scores improved significantly to 2.1 (range 0 to 6.5), 89.3 (range 67 to 100), and 84.7 (range 55 to 100) postoperatively (p < .001). The mean preoperative tibial–anterior surface angle and talar tilt angle were 84.9° (range 78° to 90°) and 8.3° (range 3° to 21°), respectively. At the most recent follow-up visit, the corresponding values were 95.0° (range 82° to 99°) and 1.8° (range 0° to 8°), respectively (p < .001). Computed tomography scans indicated that the ankle mortise narrowed by approximately 1.8 mm and the tibial plafond was lowered after osteotomy. No patients underwent lateral ligament reconstruction, ankle joint replacement, or arthrodesis. Mortise-plasty osteotomy corrects the intra-articular and extra-articular deformities simultaneously and provides good clinical and radiographic outcomes for patients with varus ankle osteoarthritis and instability.

A comparative study of the feet of middle-aged women in Korea and the Maasai tribe.

BackgroundMembers of the Maasai tribe spend their days either barefoot or wearing traditional shoes made from recycled car tires. Although they walk long distances (up to 60 km) daily, they do not generally experience foot ailments. Here, we compared parameters associated with the feet, ankles, and gait of middle-aged women in Korea and the Maasai tribe.MethodsFoot length, calf circumference, hindfoot alignment, step length, cadence, and walking velocity were compared among 20 middle-aged Korean and bush-living Maasai women. Static and dynamic Harris mat footprints were taken to determine the distribution of forefoot pressure patterns during walking. We also compared several radiographic parameters with standing foot and ankle radiographs.ResultsThe mean foot length and width were significantly longer in Maasai women. Interestingly, 38 ft (96 %) in the Maasai group showed a claw deformity of the toe (s). There were no statistically significant differences in gait-related indices and Harris mat findings between the two groups. On radiographic analysis, tibial anterior surface angle, tibial lateral surface angle, talonavicular coverage angle, talo-first metatarsal angle, Meary angle, and naviculo-cuboidal overlap were significantly greater in the Maasai group, whereas hallux valgus angle and the first and second intermetatarsal angle were greater in the Korean group.ConclusionsMiddle-aged women from the Maasai tribe showed a higher prevalence of abducted forefeet, everted hindfeet, and fallen medial longitudinal arches than did Korean women, while Korean women showed a higher prevalence of hallux valgus, a preserved medial longitudinal arch, and toes that are free from claw deformity.

Change of the X-ray Beam Angle may Influence Ankle Image of Weight-bearing Anteroposterior View: Trial to Evaluate Ankle Joint on Standing Whole-leg Radiograph

Upon evaluating the ankle joint structures by using standing whole-leg anteroposterior (AP) radiographs, the angle at which the X-ray beam is projected to the ankle joint, may distort the image. The accuracy and validity of the measurement of the ankle joint structure was investigated using weight-bearing AP radiographs obtained at several angles of X-ray beam projection for the clinical availability. Three weight-bearing AP view radiographs of each limb were acquired upon projecting the X-ray beam cranially, and at 0°, 5°, and 10° to the ankle joint. The tibial anterior surface angle (TAS angle), tibial medial malleolus angle (TMM angle), and tibial bimalleolus angle (TBM angle) were measured on each weight-bearing AP view of the ankle joint. The measurements of the TAS, TMM, and TBM angles were then statistically compared. The TAS angle did not change as the projected angle increased. No significant differences were observed between the groups. The TMM angle decreased gradually as the projected angle increased. A significant difference was observed between 0° and 10°. The TBM angle increased gradually as the projected angle increased. A significant difference was observed in the TBM angle between 0° and 5° as well as between 0° and 10°. The TAS angle, which indicates varus/valgus deformity of the ankle joint, can assessed with the projected angle of 10°.

Radiologic Changes of Ankle Joint after Total Knee Arthroplasty

The authors noticed that ankle joint osteoarthritis was not uncommon when lower extremity malalignment, such as a knee varus deformity, was present as a result of severe osteoarthritis of the knee. The purpose of this study was to analyze radiologic changes of the ankle joint after total knee arthroplasty. This study included 142 cases in 110 patients who underwent total knee arthroplasty and were followed for at least 3 years. The varus knee group included 128 cases and the valgus knee group included 14 cases. On anteroposterior standing lower extremity radiographs, varus and valgus angles of the knee were measured preoperatively and at the last follow-up. The angle between the ground surface and the distal tibial plafond as well as the upper talus was also measured. In addition, tibial anterior surface angle, talar tilt, space between the medial malleolar distal tip and the medial articular surface of the talus, and medial tibiotalar joint space of the ankle joint were measured. Out of 142 cases, 50 (35.2%) had arthritis in the ankle before total knee arthroplasty and 31 (21.8%) had newly developed or progressive arthritis after surgery. In particular, the varus knee group demonstrated statistically significant differences in preoperative varus deformity, preoperative talar tilt, and postoperative correction angle between the cases that developed or had progressive arthritis and those that did not show any changes (p < .05). After total knee arthroplasty, arthritis developed or progressed in the ankle of many cases radiographically. In particular, when the preoperative talar tilt increased medial to the ankle or the postoperative correction angle was large, the incidence of arthritis in the ankle joint increased. The authors recommend more cautious follow-up on the symptoms of the ankle joint after total knee arthroplasty.

Periarticular osteotomy in the treatment of ankle arthritis

Objective To evaluate effect of periarticular osteotomy in the treatment of asymmetrical ankle arthritis.Methods Sixty-five patients with asymmetrical ankle arthritis were treated with periarticular osteotomy between February 2005 and May 2011,including 43 females and 22 males,aged from 35 to 74 years (mean,55.5 years).According to the Takakura classification of ankle arthritis,there were 29 patients in grade 2,32 in grade 3 and 4 in grade 4.Supramalleolar tibial osteotomy were performed in 20 patients,supramalleolar tibial and fibular osteotomy in 12,supramalleolar osteotomy combined with calcaneal osteotomy in 30 patients,and supramalleolar tibial and fibular osteotomy combined with calcaneal osteotomy in 3patients.Forty three patients underwent ligament reconstruction procedures.Based on radiographs,the tibial anterior surface angle (TAS) and tibial lateral surface angle (TLS) were compared before and after operation.AOFAS-AH score was used to evaluate the function of the ankle.Results Fifty-nine patients were followed up for an average of 35.7 months (range,7 to 94 months).Bone healing was observed in all patients,and the average healing time was 7 to 8 weeks.The average AOFAS-AH score was improved from 49.7 points preoperatively to 78.6 points 12 months postoperatively.Tbe average TAS and TLS was improved from 86.1° and 70.0° preoperatively to 93.9° and 81.5° 6 months postoperatively,respectively.Delayed wound healing occurred in 5 patients,which was resovled after nursing care.Forty-two patients felt excellent about results,15 felt good and 2 fell fair.Conclusion Perarticular osteotomy is a sound method in the treatment of asymmetrical ankle arthritis,based on chosing proper patients.The procedure can decrease the contact pressures on the degenerated cartilage and prolong the life span of the ankle. Key words: Ankle; Arthritis; Osteotomy

Alignment of Ankle and Hindfoot in Early Stage Ankle Osteoarthritis

Supramlleolar osteotomy has been recommended to correct varus deformity of the tibial plafond, however we have seen only a few ankles with significant deviation of alignment in early stage osteoarthritis, in which realignment treatments might be necessary to modify the course of the disease. Our hypothesis was that there are diverse radiographic features of the tibial plafond and hindfoot in varus ankle osteoarthritis. The study included 154 ankles of 98 patients with medial osteoarthritis, and 80 ankles of 80 normal subjects. On weightbearing AP radiographs, the tibial anterior surface angle (TAS), tibial axis-medial malleolus angle (TMM) and talar tilt angle was measured. On weightbearing lateral radiographs, tibial lateral surface angle (TLS) was measured. On the hindfoot alignment view, the heel alignment angle and heel alignment ratio were obtained. Inter- and intraobserver reliabilities were obtained for all radiographic parameters. The radiographic parameters were compared among the normal ankles and the ankles in different stages of ankle arthritis by the Takakura classification. Inter- and intraobserver reliability were very high for all radiographic parameters except TLS. There was no statistically significant difference in TAS among stages 2, 3a, and 3b. TAS was 86.9 +/- 2.4 degrees, 86.2 +/- 3.3 degrees, and 85.4 +/- 4 3.1 degrees in stage 2, 3a, 3b, respectively. There was no significant difference in hindfoot alignment among normal, stage 2, stage 3a. The hindfoot alignment angle was 0.5 +/- 8.1 degrees, 0.5 +/- 6.8 degrees, and 9.6 +/- 9.1 degrees in Stage 2, 3a, 3b, respectively. Alignment of the tibial plafond and hindfoot was variable in early stage ankle osteoarthritis. III, Retrospective Case Control Study