Tibiocalcaneal Angle Research Articles

Correction of progressive collapsing foot deformity classes after isolated arthroscopic subtalar arthrodesis

IntroductionSubtalar osteoarthritis in the context of flatfoot (recently renamed Progressive Collapsing Foot Deformity (PCFD)) may be treated through subtalar joint (SJ) arthrodesis with anticipated consequences on three-dimensional bony configuration. This study investigates the correction of PCFD-related deformities achieved after Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA). MethodsIn this retrospective study, we evaluated pre- and post-operative (at 6 months) weight bearing computed tomography (WBCT) images of patients diagnosed with PCFD with a degenerated SJ (2 A according to PCFD classification) and/or peritalar subluxation (2D) with or without associated flexible midfoot and/or forefoot deformities (1B, 1 C and 1E) which underwent ALAPSTA as a standalone procedure between 2017 and 2020. Multiple measurements were used to assess and compare pre and post-operative PCFD classes. ResultsThirtythree PCFD (33 patients, median age 62) were included in the study. Preoperative medial facet subluxation was 28.3 % (IQR, 15.1 to 49.3 %). Overall PCFD 3D deformity improved with a reduction of the foot and ankle offset from 9.3 points (IQR, 7.8 to 12) to 4 (IQR, 0.9 to 7) (p < 0.001). Class A-hindfoot valgus (median tibiocalcaneal angle and median calcaneal moment arm improved by 9.4 degrees (p < 0.001) and 11 mm (p < 0.001), respectively), class B-midfoot abduction (median talonavicular coverage angle improved by 20.5 degrees, p < 0.001) and class C-forefoot varus (median sagittal talo-first metatarsal angle improved by 10.2 degrees (p < 0.001)) were significantly corrected after surgery. Class D was difficult to assess due to the fusion procedure. No patient had a pre-operative valgus deformity at the ankle (no class E), and no significant change of the talar tilt was observed (p = 0.12). ConclusionIn this series, ALAPSTA performed as a standalone procedure to treat patients diagnosed with PCFD with a degenerated subtalar joint and/or peritalar subluxation was effective not only at correcting hindfoot alignment but also flexible midfoot abduction and flexible forefoot varus. Level of evidenceLevel IV, case series

Corrective Efficacy of Calcaneal Lengthening Osteotomy for Planovalgus Deformity in Cerebral Palsy Patients.

Introduction Planovalgus deformity is common in children with spastic cerebral palsy (CP), particularly spastic diplegia and spastic quadriplegia. It results from muscle imbalance over the immature foot skeleton, leading to hindfoot valgus, forefoot abduction, and joint subluxation. Surgical interventions, like calcaneal lengthening osteotomy (CLO), are frequently employed to correct this deformity, but objective guidelines for its use in CP patients are lacking. Material and methods This retrospective cohort study examined the efficacy of CLO in correcting plano valgus deformity in pediatric CP patients at the Pediatric Orthopedic Unit of Christian Medical College (CMC) in Vellore, India. Data from patient records and radiographs were collected, including demographics, pre- and postoperative angles, and surgical details. Statistical analysis was performed to assess changes in angles and associations with various factors. Results After the surgery, there was a notable enhancement in the calcaneal pitch, lateral talo-first metatarsal angle, and naviculocuboid overlap, as shown by the CLO results. However, tibiocalcaneal angles did not show significant changes. Associations were observed between age, Gross Motor Function Classification System (GMFCS) level, additional surgeries, and postoperative angle corrections. Conclusion CLO shows promise in correcting plano valgus deformity, with age, GMFCS level, and comorbidities influencing outcomes. Long-term follow-up is crucial to monitor correction durability. Specific radiographic angles provide insights into CLO's biomechanical effects, but study limitations warrant caution in interpretation. CLO effectively corrects plano valgus deformity in pediatric CP patients, with age, GMFCS level, and comorbidities influencing outcomes. Long-term follow-up and further research are needed to optimize management strategies and enhance understanding of surgical outcomes.

Correlation analysis between Pirani score and talo-navicular angle,calcaneo-cuboid angle and tibio-calcaneall angle of infant clubfoot under ultrasound

Objective: To explore the evaluation effect of ultrasonography and Pirani score on tarsal deformity, treatment effect and pseudo-correction of congenital clubfoot in infants and young children, and the correlation between the two methods. Methods: This is a retrospective case series study. The clinical data of 26 children (40 feet) with congenital clubfoot who were evaluated by ultrasonography in the Third Affiliated Hospital of Zhengzhou University from January 2020 to January 2023 were retrospectively collected. There were 16 males and 10 females. The age at the first ultrasound examination was (M(IQR)) 9.0 (18.0) days (range: 1 to 46 days). All patients were treated with Ponseti method by the same physician. The Pirani scores before and after treatment and at the last examination, and the talonavicular angle, calcaneocuboid angle and tibiocalcaneal angle measured by ultrasound were collected, and the treatment and follow-up were recorded. Paired sample t test, repeated measures analysis of variance or Kruskal-Wallis test were used for data comparison, and Spearman correlation analysis was used for correlation analysis. The receiver operating characteristic curve was used to calculate the efficacy of ultrasound in evaluating different Pirani scores. Results: The number of plaster fixation in 26 children was 4.0 (1.0) times (range: 2 to 8 times). The medial talonavicular angle and posterior tibiocalcaneal angle were significantly improved after treatment and at the last follow-up compared with those before treatment, and the differences were statistically significant (all P<0.01). There was no difference in lateral calcaneocuboid angle before and after treatment and at the last follow-up (F=1.971, P>0.05). Pseudo-correction occurred in 2 cases (2 feet) during the treatment, with an incidence of 5%. Correlation analysis showed that there was a moderate positive correlation between talonavicular angle and Pirani midfoot score (r=0.480, P<0.01). There was no correlation between calcaneocuboid angle and Pirani midfoot score (r=0.114, P=0.105). There was a moderate negative correlation between tibial heel angle and Pirani hindfoot score (r=-0.566, P<0.01). The cut-off point of Pirani midfoot score of 1.5 was 38.78°, the sensitivity was 0.90, the specificity was 0.56, and the area under the curve was 0.75. The cut-off value of angle was 27.51 °, the sensitivity was 0.16, the specificity was 0.92, and the area under the curve was 0.44.The cut-off points of Pirani midfoot score of 3.0 were 45.08°and 9.96°, the sensitivity was 0.94 and 0.91, the specificity was 0.37 and 0.42, and the area under the curve was 0.59 and 0.62, respectively. The cut-off values of Pirani hindfoot score of 2.0 and 3.0 were 167.46° and 160.15°, respectively. The sensitivity was 0.75 and 0.67, the specificity was 0.81 and 0.83, and the area under the curve was 0.78 and 0.71, respectively. Conclusion: Ultrasound can complement with Pirani score, visually and dynamically observe the morphology and position changes of talonavicular joint, calcaneocuboid joint and tibiotalocalcaneal joint, monitor the recovery and pseudo-correction of tarsal bones, and better evaluate the therapeutic effect.

Extensive Posteromedial Soft Tissue Release for Skeletally Mature Patients With Rigid Pes Cavus Deformity

Introduction: Adult-onset cavovarus foot deformity is a highly disabling condition that can seriously interfere with daily activities. Charcot-Marie-Tooth is the most common etiology associated with cavus foot. Patients and Methods: We reviewed 30 feet in skeletally mature patients with rigid cavovarus deformities who were treated with extensive posteromedial soft tissue release without performing osteotomies or internal fixation. Clinical evaluation was done using the Foot Function Index for the pain, disability, and limitation of movement. The radiologic assessment was done by measurement of the lateral talo-first metatarsal angle, the lateral calcaneal-first metatarsal angle, and the lateral tibio-calcaneal angle in standing lateral foot radiographs. All patients were followed up for a mean of 36 months postoperatively. Results: Throughout the course of the study, the Foot Function Index for pain, disability, and limitation improved from an average of 51.46 points, 47.06 points, and 22.6 points preoperatively to postoperative averages of 23.65 points, 21.88 points, and 10.2 points, respectively. Radiologically, the talo-first metatarsal angle, the calcaneo-first metatarsal angle, and the tibio-calcaneal angles had preoperative values of 28.9 degrees, 132.4 degrees, and 62.35 degrees which improved postoperatively to 7.55 degrees, 117.65 degrees and 50.35 degrees, respectively. Conclusion: The outcomes of this study shed light on the use of pure soft tissue release without associated osteotomies as a simple, safe, and effective technique in treating rigid cavovarus deformities in skeletally mature patients. This could carry some advantages regarding preserving foot function as it preserves the integrity of foot joints. Level of Evidence: Level IV.

Simple Talectomy is a Beneficial Surgical Procedure for Talipes Equinovarus and Other Severe Neuromuscular Foot Deformities

Noninvasive techniques are gold standard to redress Severe Neuromuscular Foot Deformity (SNFD). However, simple talectomy may be considered to obtain a stable, plantigrade, pain-free foot. We present a 10-year follow-up accessing radiological correction rates, functional outcomes, complications, and patient satisfaction. This retrospective case series evaluated talectomies in 2012 to 2022. Simple talectomy was combined with Steinman pin fixation of calcaneus to tibia for approximately 6 weeks. Diagnoses primarily included arthrogryposis multiplex congenita and cerebral palsy. Indications were pain, wounds/pressure marks, severe rigidity, and residual/recurrent deformity. The primary outcome was radiological correction. Tibiotalar angle (TiTa) and tibiocalcaneal angle (TiCa) were measured on mediolateral projections. Secondary outcomes were functional scores of pain/deformity graded as good, fair or poor. Furthermore, validated patient-reported outcome measures, that is, EQ-5D-5L and the Scoliosis Research Society-30 Questionnaire (2 items) assessed health-related quality of life and patient satisfaction. Nineteen talectomies in 11 patients were analyzed. Mean follow-up was 62 months (range 9-112 months). Mean TiTa was 137° (95%CI 128;146). TiCa improved significantly: Mean difference -24° (95%CI -44;-5, p = .02). All feet became plantigrade and pain-free with no skin issues. Functional outcomes were graded as 9/19 good, 10/19 fair and 0/19 poor. Parents/primary caregivers were mainly satisfied. Perceived health was 54 (95%CI 34;75) out of 100 on a visual analogue scale, emphasizing complex medical conditions. In conclusion, simple talectomy is a suitable salvage procedure for SNFD.

Radiographic Impact on the Clinical Decision Making of Achilles Tenotomy in Clubfoot: In Search of an Objective Cut-Off Value

Background: We tried to determine whether the indication of Achilles tenotomy (AT) in clubfoot patients based on clinical evaluation could be confirmed radiographically, and to find an objective radiographic cut-off value for its indication. Methods: Eighty-six clubfeet from 60 patients, (26 bilateral and 34 unilateral) were included. A standard Ponseti treatment regimen was applied. Group 1 comprised patients who underwent AT immediately after serial plaster casting (26 feet). Group 2 comprised patients who underwent AT during the follow-up period (48 feet). Group 3 comprised patients who were assumed to have a corrected foot and did not undergo AT (12 feet). Group 4 comprised the healthy sides of the unilateral cases (34 feet). Results: Both Group 1 and Group 2 showed significant improvement after tenotomy (p = 0.002). In order to differentiate between the normal and AT groups according to the pre-tenotomy angle, we obtained an optimal cut-off value of &gt;85° according to the Youden index, a sensitivity of 96%, a specificity of 91.2%, a positive predictive value of 95.9%, a negative predictive value of 91.2%, and an accuracy rate of 94.4% (AUC: 0.983; p &lt; 0.001). Conclusions: Feet with a lateral tibio-calcaneal angle &gt; 85° can be considered pathologic and accepted as candidates for AT.

Clinical and Sonographic Evaluation of Percutaneous Achilles Tendon Tenotomy in Idiopathic Clubfoot: A Prospective Study

Objectives: Idiopathic Congenital Talipes Equino Varus (CTEV), commonly referred to as Clubfoot, is a complex musculoskeletal deformity affecting infants. The Ponseti technique, a gold standard approach, has emerged as an effective treatment. This study aims to evaluate the clinical and sonographic outcomes of percutaneous Achilles tendon tenotomy in children with idiopathic clubfoot who underwent the Ponseti procedure. Methods: A prospective study was conducted at the JIPMER Department of Orthopaedics, involving 41 feet with residual equinus deformity following Ponseti treatment. Infants with idiopathic clubfoot were included. Clinical and sonographic evaluations were performed, percutaneous Achilles tendon tenotomy was performed. Parameters were measured, Data were statistically analyzed using Kolmogorov-Smirnov tests, paired t-tests, ANOVA, and correlation analysis. Results: 29 infants (41 feet), primarily boys (89.7%) were studied. Following percutaneous tenotomy, clinical improvement was observed, with a mean increase in dorsiflexion of 20-25 degrees. Sonographic parameters showed significant improvement in tibio calcaneal distance, talocalcaneal divergence, and metaphyseal-talocalcaneal angle post-tenotomy (p&lt;0.05). Positive correlations were found between clinical and sonographic improvements. Conclusion: Clinical improvement of hindfoot deformity following percutaneous Achilles tendon tenotomy in idiopathic clubfeet correlates with the sonological improvement of talo calcaneal, tibio calcaneal angles and tibio calcaneal distance.

THE EFFICACY OF DISTAL TIBIAL GROWTH MODULATION IN THE TREATMENT OF PAEDIATRIC FOOT AND ANKLE DISORDERS: A RETROSPECTIVE STUDY OF CASES FROM 2003 TO 2022

AbstractObjectivesEpiphysiodesis is a commonly used treatment for lower limb angular deformities. However, in recent years, distal tibial growth modulation using ‘eight plates’ or screws has emerged as an alternative treatment for paediatric foot and ankle disorders, such as CTEV. Our objective was to assess the efficacy of distal tibial modulation in correcting various paediatric foot and ankle disorders.MethodsThis retrospective study analysed 205 cases of paediatric foot and ankle disorders treated between 2003 and 2022, including only cases where the eight plate or screw was fixed on the anterior surface of the distal tibia. Our aim was to measure post-operative changes in dorsiflexion, the distal tibial angle, and the tibiocalcaneal angle by examining clinical records and radiology reports.ResultsWe identified nine cases (nine feet) meeting the full inclusion criteria, comprising seven cases of CTEV, one case of arthrogryposis, and one case of cavovarus foot. The cohort consisted of five male and four female patients, with a mean age of 10 years and 9 months at the time of surgery. Seven cases involved the left tibia, and two cases involved the right tibia. The mean time between pre-operative X-ray to surgery was 168 days, and the mean turnaround time between surgery and post-operative X-ray was 588 days. A mean change in the distal tibial angle of 4.33 degrees was noted. However, changes in dorsiflexion were documented in only one case, which showed a change of 13 degrees. Notably, our average distal tibial angle was significantly lower than reported in the literature, at 4.33 degrees. Additionally, some studies in the literature used the Oxford Ankle Foot Questionnaire for Children to assess pre- and post-operative outcomes, but it is important to note that it is validated only for children aged 5 to 16. Furthermore, most cases reported an improved tibiocalcaneal angle except for an anomaly of 105 degrees. We assessed satisfactory patient outcomes using patient notes. Out of the 6 procured notes, one has been discharged. The rest are still under yearly or 6-monthly review and are at various stages, such as physiotherapy, removing the eight plate, or requiring further surgery. The most common presentations at review are plantaris deformity and pain.ConclusionsOur study suggests that distal tibial growth modulation can be an effective treatment option for selected paediatric foot and ankle disorders. However, due to the limited number of cases in our study, the lack of documentation of changes in dorsiflexion, and a lack of pre- and post-operative outcomes using a standardised method, further research is needed to investigate this procedure's long-term outcomes and potential complications.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Clubfoot Deformity Treatment with Ilizarov Apparatus in the Paediatric Population without Corrective Osteotomies and Soft Tissue Release: A Cross-Sectional Study.

Neglected Club Foot deformity is not an uncommon limb anomaly encountered by orthopaedic surgeons. Many treatment methods have been proposed. Ilizarov apparatus is one of the techniques used to correct this deformity. In this cross-sectional study 47 patients (56 feet) between the ages of 5 and 10 years with clubfoot deformity were treated using the Ilizarov external fixator. Age, sex, type of deformity, and radiographic parameters were measured on foot radiographs. Also, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Dimeglio classification were recorded for each patient before and after treatment. The treatment was unilateral in 38 patients and bilateral in 9 patients. 39 patients (69.6%) were male, and 17 patients (30.4%) were female with a mean age of 7.86 ± 1.4 years. Plantar angles of ankle flexion and ankle flexion curve increased from 20.12±6.52 and -16.51±8.36 to 25.89±6.44 and 6.19±6.42, respectively. There was also an improvement in the talocalcaneal and tibiocalcaneal angles. Also, the angle between the first metatarsus and the talus in the front and side views improved (P<0.00). Additionally, the mean AOFAS score and Dimeglio classification significantly improved. Three cases were complicated with distal tibial physeal separation that were treated with additional open surgeries. Ilizarov technique without osteotomies and soft tissue release could be considered a less invasive and successful method of treatment for neglected clubfoot deformity in patient five to ten years old that are not good candidate for Ponseti method.

Joint preservation surgery for correcting adolescents' spasmodic flatfoot deformity: early results from a specialized North African foot and ankle unit.

We aimed to report early results of performing joint-preserving surgeries for managing spasmodic flatfoot deformity (SFFD) in adolescents. A prospective case series study including 24 patients (27 feet) diagnosed with idiopathic SFFD not responding to conservative management. After reassessment under anesthesia, surgical procedures included soft tissue releases (Achilles tendon (AT), peroneus brevis (PB), peroneus tertius (PT) (if present), and extensor digitorum longus (EDL)), bony osteotomies (lateral column lengthening (LCL), medial displacement calcaneal osteotomy (MDCO), and double calcaneal osteotomy (DCO)), and medial soft tissue reconstruction or augmentation if needed. Functional evaluation was performed per the American Orthopedic Foot and Ankle Society (AOFAS) score, while radiological parameters included talo-navicular coverage angle (TNCA), talo-first metatarsal angle (AP Meary's angle), calcaneal inclination angle (CIA), talo-calcaneal angle (TCA), talo-first metatarsal angle (Lat. Meary's angle), and tibio-calcaneal angle (TibCA). The preoperative parameters were compared to the last follow-up using the Wilcoxon signed test. The mean age was 15.37 ± 3.4 years, 18 (75%) were boys, and the mean BMI was 28.52 ± 3.5 (kg/m2). Release of AT and fractional lengthening of PL, PT, and EDL were performed in all patients. LCL was needed in eight feet (29.6%), MDCO in 5 (18.5%), and DCO in 14 (51.9%). FDL transfer was required in 12 (44.4%) feet, and repair of the spring ligament in seven (25.9%). The mean operative time was 99.09 ± 15.67 min. All osteotomies were united after a mean of 2.3 ± 0.5 months. After a mean follow-up of 24.12 ± 8.88 months (12 and 36 months), the AOFAS improved from a preoperative mean of 43.89 ± 11.49 to a mean of 87.26 ± 9.92 (P < 0.001). All radiological parameters showed significant improvement, AP Meary's angle from a mean of 20.4 ± 5.3 to a mean of 9.2 ± 2.1, Lat. Meary's angle from - 15.67° ± 6.31 to - 5.63° ± 5.03, TNCA from - 26.48° ± 5.94 to 13.63° ± 4.36, CIA from 12.04° ± 2.63 to 16.11° ± 3.71, TibCA from - 14.04° ± 3.15 to - 9.37° ± 3.34, and TCA Lat. from 42.65° ± 10.68 to 25.60° ± 5.69 (P ≤ 0.001). One developed wound dehiscence (over an MDCO), managed with daily dressings and local antibiotics. Another one developed lateral foot pain after having LCL managed by metal removal. Careful clinical and radiological evaluation for the correct diagnosis of SFFD is paramount. Joint-preserving bony osteotomies combined with selective soft tissue procedures resulted in acceptable functional and radiological outcomes in this young age group.

Influence of Distal Reference Point of the Tibial Mechanical Axis on the Ankle and Hindlimb Alignment Change after Total Knee Arthroplasty.

The alignment philosophy in total knee arthroplasty (TKA) has tended to shift from the gold standard of mechanically aligned technique to personalized alignment, such as the kinematically aligned (KA) technique. However, the influences of different surgical techniques on lower limb alignment relative to the ground are not fully investigated. This study investigated the influence of the ankle and hindlimb alignment change after mechanically aligned TKA and KA-TKA. The varus osteoarthritic patients who underwent TKAs were divided into a mechanically aligned TKA group (group M, n = 50) and a KA-TKA group (group K, n = 50). Radiographic parameters (hip-knee-calcaneus [HKC] angle, hip-knee-ankle [HKA] angle, talar tilt angle [TTA], and tibiocalcaneal angle [TCA]) were investigated using full-length standing radiographs. The deviation angle (ΔTA; angle between the tibial mechanical axis [TMA] and the ground tibial mechanical axis [gTMA]) and the change of ΔTA (cΔTA) were also assessed. These parameters were compared between the two groups, along with the correlation between the preoperative HKA angle and other parameters. ΔTA, TTA, and TCA showed no differences between the groups pre- and postoperatively, and no significant changes were observed postoperatively. The preoperative HKA angle showed a significant negative correlation with cΔTA in both groups (group M: r = -0.33, p = 0.02; group K: r = -0.29, p = 0.04) although no correlation was observed the with preoperative TTA and TCA. Despite no change in ΔTA after surgery, the preoperative varus deformity was associated with a change in the deviation between gTMA and TMA after surgery. A severely varus knee may be inappropriate for ground KA-TKA.

Comparison of Clinico-Radiographic Outcome of the 3-Component Salto Total Ankle Arthroplasty According to Degree of Ankle Varus Deformity for End-Stage Ankle Arthritis

Category: Ankle Arthritis Introduction/ Purpose: As the popularity of total ankle arthroplasty (TAA) increases, indication of TAA also expands. Recently, the ankles more than 20º of varus or valgus deformity in the coronal plane are treated with TAA. Commonly, patients with ankle osteoarthritis have preoperative varus deformity. However, preoperative varus deformity should be corrected in the coronal plane to avoid residual mal-alignment that leads to instability, insert wear, and clinical failure. In this study, we compare the clinical and radiologic outcome of the Salto mobile bearing 3-component total ankle prosthesis for ankles according to preoperative degree of ankle varus deformity. Methods: TAA was performed in 106 ankles using 3-component Salto total ankle implant from June 2014 to October 2019. A prospectively collected database was used to identify all patients who underwent primary TAA with a minimum 1-year follow-up. All patients were followed up at postoperative three months, six months, at one year and yearly thereafter. Clinical outcome scoring was done pre-operatively and post-operatively. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Post-operative coronal alignment of the component were evaluated with radiographs. More than 10º of tibial anterior surface angle, talta tilt angle (TTA), tibial axis-talar dome angle (T-TDA), talar dome-ground surface angle (TD- GSA), or tibio-calcaneal angle (TCA) was defined as varus deformity. We classified the enrolled ankles as neutral ( &lt; 10 º), moderate varus (10º~20º), and severe varus groups (&gt;20º). Results: The average follow-up was 21.9 months (range, 12-72). Preoperatively, there were 37 ankles (35%) with neutral alignment, 48 ankles (45%) with moderate varus deformity, and 21 ankles (20%) with severe varus deformity. There were no significant differences in mean pain VAS, AOFAS score, and ROM among the groups (p &gt; 0.05). Overall satisfaction rate (more than satisfied) was 87%, and no significant differences were found among the groups. As to radiographic alignment, there were no significant differences among the groups in T-TDA and TD-GSA (p &gt; 0.05). Concomitant additional procedures such as deltoid release, calcaneal osteotomy, and first tarsometatarsal dorsiflexion arthrodesis were more significantly performed in preoperative varus groups. Conclusion: There was no significant difference in clinical and radiographic outcomes a according to degree of ankle varus deformity in the TAA series using single Salto 3-componenet implant. Postoperative neutral alignment was achieved in all ankles. For favorable long-term outcomes, coronal alignment should be corrected with proper additional procedures in TAA.

The morphology of osseous structure in subtalar joint with chronic ankle instability

BackgroundOsseous structures have been demonstrated as risk factors for chronic ankle instability (CAI). Previously, the researchers only focused on the osseous structures of ankle, but ignored the osseous structures of subtalar joint(STJ). Accordingly, the aim of our study was to investigate the morphological characteristics of STJ osseous structures in CAI. Methods52 patients with CAI and 52 sex- and age- matched control subjects were enrolled from The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. The lateral radiographs of ankle in weight-bearing were used to compare the diversity of the two groups. Specifically, The Length of calcaneus, Calcaneal facet height and Absolute foot height, Böhler's angle, Gissane's angle, Calcaneal inclination angle, Talocalcaneal angle, Tibiotalar angle, Tibiocalcaneal angle, Talar-horizontal angle, talar declination angle, facet inclination angle were gauged in the two groups. ResultsThe Böhler's angle, Calcaneal inclination, Talocalcaneal angle, Tibiotalar angle, Talar-horizontal angle, Talar declination angle, Facet inclination angle and Absolute foot height of CAI group were significantly higher than normal control group (P < 0.05). There were no significant differences in Gissane's angle, Tibiocalcaneal angle, Length of calcaneus and Calcaneal facet height between patients with CAI and normal controls (P > 0.05). ConclusionsThe osseous structures of STJ in CAI patients are different from normal people in morphology. Therefore, we should pay more attention to the changes of STJ anatomical parameters in the diagnosis and prevention of CAI. Level of evidenceⅢ.

Hindfoot Alignment and Ankle Stability Following Arthroscopic Lateral Ankle Ligament Repair.

Hindfoot varus deformity is a known risk factor for chronic lateral ankle instability (CLAI). The impact of this deformity on clinical results following arthroscopic lateral ankle ligament repair (ALLR) for CLAI has not been studied. Sixty-three ankles from 62 patients who received ALLR for CLAI were retrospectively examined. Preoperative plain radiographs were used to measure tibial articular surface (TAS) angles, and long axial hindfoot alignment radiographs were used to measure tibiocalcaneal angles (TCAs) pre- and postoperatively. Results included ratings on the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and recurrent ankle instability (respraining of the operated ankle following surgery). Recurrent ankle instability, defined as incidence of any new ankle sprain after surgery reported in the follow-up period, occurred in 13 ankles. The TAS angles of these patients were significantly low, and their preoperative TCA was significantly high. Multivariate analysis showed that preoperative TCA was an independent risk factor for recurrent ankle instability. The threshold values for preoperative TCA for recurrent instability were determined via the receiver operating characteristic curve analysis to be 3.4 degrees. Patients were assigned to a low- or high-TCA group based on the reported average TCA (2.7 degrees) of healthy patients. In the high-TCA group, recurrent instability was significantly more frequent, and the scores on the pain subscale of the postoperative SAFE-Q were significantly lower. Hindfoot varus alignment was associated with pooreroutcomes after ALLR. Level III, retrospective comparative study.

Tarsus and knee setting in children at the final stage of early childhood taking into account the six-month age ranges

Purpose The study aimed to analyze the tarsus and knee setting in 3-year-old girls and boys, taking into account the six-month age ranges. Methods The study involved 800 children (400 girls, 400 boys) recruited from randomly selected preschools in the in the Podkarpackie region. Study group was divided into two age ranges: 1st group (children aged 3.00-3.49 years) and 2nd group (children aged 3.50-3.99 years). Baseline goniometer (Fei Fabrication Ltd., USA) was used as primary research tool. The data were analyzed based on Mann Whitney U test and Student’s t test for independent samples. Results Sex differences concern only the tibio-calcaneal angle in children in the 2nd age group (right: p&lt;0.001) and left p&lt;0.001). Statistically significant differences in both girls (right lower limb: p=0.003; left lower limb: p=0.002), and boys (right lower limb: p=0.001; left lower limb: p=0.001) were found. Conclusions Boys were characterized by greater valgus of the tarsus of the right and left foot than girls. Knees of girls and boys in the 1st age group were characterized by greater valgus, compared to children from the 2nd age group.

Can immediate postoperative radiographs predict outcomes in pediatric clubfoot?

The goal of treatment for pediatric idiopathic clubfoot is to enable the patient to comfortably walk on his or her soles without pain. However, currently accepted treatment protocols are not always successful. Based on the abnormal bone alignment reported in this disease, some studies have noted a correlation between radiographic characteristics and outcome, but this correlation remains debated. To assess the correlation between immediately postoperative radiographic parameters and functional outcomes and to identify which best predicts functional outcome. To predict the outcome and prevent early failure of the Ponseti's method, we used a simple radiographic method to predict outcome. Our study included newborns with idiopathic clubfoot treated with Ponseti's protocol from November 2018 to August 2022. After Achilles tenotomy and a long leg cast were applied, the surgeon obtained a single lateral radiograph. Radiographic parameters included the tibiocalcaneal angle (TiCal), talocalcaneal angle (TaCal), talofirst metatarsal angle (Ta1st) and tibiotalar angle (TiTa). During the follow-up period, the Dimeglio score and functional score were examined 1 year after surgery. Additionally, recurring events were reported. The correlation between functional score and radiographic characteristics was analyzed using sample and multiple logistic regression, and the optimal predictor was also identified. In total, 54 feet received approximately 8 manipulations of casting and Achilles tenotomy at a mean age of 149 days. The average TiCal, TaCal, Ta1st, and TiTa angles were 75.24, 28.96, 7.61, and 107.31 degrees, respectively. After 12 mo of follow up, we found 66% excellent-to-good and 33.3% fair-to-poor functional outcomes. The Dimeglio score significantly worsened in the poor outcome group (P value < 0.001). Tical and TaCal showed significant differences between each functional outcome (P value < 0.05), and the TiCal strongly correlated with outcome, with a smaller angle indicating a better outcome, each 1 degree decrease improved the functional outcome by 10 percent. The diagnostic test revealed that a TiCal angle of 70 degrees predicts an inferior functional outcome. The TiCal, derived from lateral radiographs immediately after Achilles tenotomy, can predict functional outcome at 1 year postoperatively, justifying its use for screening patients who need very close follow-up.

The Double Calcaneal Osteotomy for Pediatric Flatfoot

Category: Hindfoot Introduction/Purpose: The double calcaneal osteotomy combines a medial calcaneal sliding osteotomy and lateral column lengthening. Corrective osteotomies, as opposed to arthrodesis and arthroereises, are preferred for foot deformity correction in children and adolescents because they preserve joint mobility, shock absorption, and avoid concerns about adjacent joint degeneration. Individually, both types of osteotomies have demonstrated efficacy in achieving deformity correction and improved functional outcomes for patients. The literature regarding outcomes of this procedure in children is sparse. This retrospective study objectively analyzes outcomes of children who underwent double calcaneal osteotomies at our institution by comparing pre and postoperative radiographs and reporting postoperative complications. To our knowledge, this study contains the largest sample size of symptomatic flatfeet analyzed with regards to double calcaneal osteotomies in children. Methods: Patients who underwent a double calcaneal osteotomy over the past 5 years at our institution were analyzed. Pre and postoperative weightbearing radiographs of the foot were measured (Figure 1). Paired t tests were used to compare pre and postoperative measurements. Statistical significance was set at α &lt; 0.05. Additional factors analyzed for each procedure include total operative time, torniquet time, hardware used for fixation, type of graft, concomitant procedures, and post-operative complications such as infection, nerve injury, nonunion, and reoperation. Results: A total of 20 patients and 26 feet were studied. Significant correction from pre to postoperative radiographic measurement was noted for the talo-first metatarsal angle, talonavicular coverage angle, calcaneal pitch, and tibiocalcaneal angle (p &lt; 0.001). Complications were noted in 3 of the 20 patients, or 3 of 26 feet, and included infection, painful hardware, and hardware failure. Conclusion: The double calcaneal osteotomy was found to be effective in correcting the radiographic parameters associated with flatfoot deformity in children and adolescents with symptomatic flatfeet. The average postoperative radiographic measurements for the 26 feet analyzed were significantly improved from preoperative measurements. Pediatric orthopedists should strongly consider the double calcaneal osteotomy for appropriate surgical candidates.

Evaluation of hindfoot and knee alignment by the hip-to-calcaneus view in patients with knee osteoarthritis and healthy individuals

BackgroundHip-to-calcaneus (HC) view is a whole-leg standing view that can visualize the hindfoot in detail. The aim of this study was to investigate the reliability and validity of tibiocalcaneal angle in HC view (H-TCA) by comparing it with that in long axial view (L-TCA). We also verified whether periarticular knee alignment parameters, measured conventionally in whole-leg standing radiography, could be measured in HC view. MethodSixty healthy volunteers and 61 patients with medial knee osteoarthritis were included. H-TCA was measured by two examiners in the healthy group, and intra-class correlation coefficients (ICCs) were evaluated. H-TCA and L-TCA were then measured in the healthy and osteoarthritis groups and correlated. Finally, we measured hip–knee–ankle angle, mechanical axis deviation ratio, mechanical lateral distal femoral angle, medial proximal tibial angle, and joint-line convergence angle in HC view and conventional whole-leg standing radiography to evaluate statistical differences and correlations. ResultsThe intra-observer and inter-observer ICCs were 0.86 and 0.76, respectively. Correlation coefficients (r) between H-TCA and L-TCA were r = 0.87 in healthy group and r = 0.81 in osteoarthritis group, indicating a strong positive correlation in both groups. There was no significant difference in periarticular knee alignment parameters between HC view and conventional whole-leg radiography. ConclusionsHindfoot evaluation in HC view showed high intra-observer and inter-observer reliabilities and strong positive correlation with TCA in long axial view. By using HC view before knee surgery, such as total knee arthroplasty, other necessary alignments can be evaluated simultaneously.

Diagnostic Value of Lateral Ankle Radiography in Achilles Tendon Rupture.

Achilles tendon rupture (ATR) is a common sports injury, but approximately 20% of acute ATR cases are misdiagnosed as ankle sprains at first presentation. This study aimed to investigate the diagnostic value of lateral ankle radiography in the diagnosis of acute ATR. This was a retrospective case-control study in which the lateral ankle radiographs of patients who presented to the emergency department between January 1, 2015 and December 31, 2019 were examined. The study included a total of 154 patients with acute ATR, who underwent lateral ankle radiography at the presentation and were surgically or magnetic resonance imaging (MRI) confirmed to have ATR in our hospital. The lateral ankle radiographs of the patients were examined by 2 clinicians blinded to clinical data for the following 3 findings: Kager's fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle. The same procedure was repeated for 308 controls who underwent lateral ankle radiography and were diagnosed with ankle sprain. Kager's fat pad sign was detected in 133 (86.4%) of the 154 patients with ATR and 26 (8.4%) of the 308 patients in the control group. The Kager's fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle sensitivity values for the diagnosis of ATR were 86.4%, 61.7%, and 65.6%, respectively, and their specificity values were 91.6%, 78.9%, and 56.2%, respectively. Interobserver reliability was determined to be good for all 3 radiographic findings. Clinicians should be particularly aware of Kager's fat pad sign when examining lateral ankle radiographs for ankle injury. Level IV: Case control study.

Magnetic Resonance Imaging of Clubfoot Treated With the Ponseti Method: A Short-Term Outcome Study.

ObjectiveTo quantitatively evaluate the effectiveness of the Ponseti method for the correction of clubfoot, we decided to use magnetic resonance imaging (MRI) to evaluate changes in the tarsal bone relationship.MethodsThis is a retrospective study of fifteen children with clubfeet who were treated with the Ponseti method. MRI studies were obtained using a 3.0T Machine (GE Healthcare, United States). T1-weighted and T2-weighted images were acquired in the standard anatomic sagittal, transverse, and coronal planes. For the measurement, the best slice that clearly demonstrated the anatomy was chosen. Sagittal talocalcaneal angle, sagittal tibiocalcaneal angle, coronal tibiocalcaneal angle, transverse talar neck angle, transverse talonavicular angle, and transverse talocalcaneal angle were measured. The eighteen corrected clubfeet were compared with the twelve unilateral normal feet at clinical and radiological levels using a Pirani scoring system and MRI, respectively.ResultsIn total, 15 cases (twelve boys and three girls) with clubfeet were examined by using MRI. Twelve cases had unilateral and three had bilateral involvement (eleven left clubfeet and seven right clubfeet), giving a total of eighteen clubfeet when compared with twelve normal feet. The mean age of patients at examination was 47.7 months (8–96 months). The recovery of the corrected clubfoot in these patients met the goals of Ponseti treatment (functional, normal looking, pain-free, and plantigrade foot). Before Ponseti treatment, the mean Pirani score of clubfoot was 5.5 (5–6). During this follow-up, the Pirani score was 0.07 (0–0.05). The results of the MRI indicated that only the transverse talonavicular angle showed a significant difference between the treated clubfeet and the normal feet (p < 0.001). One case had dorsal talonavicular subluxation in the sagittal plane and had the lateral subluxation of the navicular in the transverse plane, which has never been reported in previous studies.ConclusionAlthough the appearance and function of clubfoot were recovered well after the Ponseti method, the results of MRI indicated that the Ponseti method successfully corrected the varus, cavus, and equinus deformities and incompletely corrected the adduction deformity regarding transverse talonavicular angle. At the same time, the Ponseti method may cause dorsal talonavicular subluxation in the sagittal plane and lateral subluxation of the navicular in the transverse plane on MRI.