Decreased Peritalar Subluxation in Progressive Collapsing Foot Deformity with Ankle Valgus Tilting

Autor: Nacime Salomao Barbachan Mansur, MD, PhD, Matthieu Lalevee, MD, MSc, Alan Shamrock, MD, Francois Lintz, MD, MSc, FEBOT, Kepler Alencar Mendes de Carvalho, MD, Cesar de Cesar Netto, MD, PhD
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: JBJS Open Access, Vol 8, Iss 4 (2023)
Druh dokumentu: article
ISSN: 2472-7245
DOI: 10.2106/JBJS.OA.23.00025
Popis: Background:. Middle facet subluxation (MFS) has been established as an early indicator of peritalar subluxation. However, when progressive collapsing foot deformity (PCFD) affects the ankle leading to a valgus talar tilt (Class E), structures and anatomic relationships distal to the ankle joint may be affected. Therefore, this study aimed to assess radiographic parameters of peritalar subluxation in patients with PCFD who either did or did not have a valgus ankle. Our hypothesis was that these parameters would differ in Class E patients, upsetting their capability to quantify deformity. Methods:. We performed a prospective comparative study utilizing weight-bearing computed tomography (WBCT) images of 21 feet with PCFD and with valgus of the ankle and 64 with flexible PCFD without ankle involvement. Parameters including MFS, the medial cuneiform-to-floor distance, the forefoot arch angle, the talonavicular coverage angle, the hindfoot moment arm (HMA), the foot-ankle offset (FAO), and the talar tilt angle (TTA) were measured and compared. Variables that influence the presence of ankle valgus and overall alignment were assessed by multivariable regression models. Results:. Patients with PCFD and ankle valgus demonstrated a higher mean HMA (20.79 mm [95% confidence interval (CI), 17.56 to 24.02 mm] versus 8.94 mm [95% CI, 7.09 to 10.79 mm]), FAO (14.89% [95% CI, 12.51% to 17.26%] versus 6.32% [95% CI, 4.96% to 7.68%]) and TTA (95% CI, 17.10° [14.75° to 19.46°] versus 2.30° [95% CI, 0.94° to 3.65°]) and lower mean MFS (21.84% [95% CI, 15.04% to 28.63%] versus 38.45% [95% CI, 34.55% to 42.34%]) compared with the group without ankle valgus (p < 0.0001 for all). The FAO was influenced by MFS in the group without ankle valgus (p
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