ANALYSIS AND PLANNING OF HINDFOOT DEFORMITY CORRECTION IN SAGITTAL PLANE

Cover Page


Cite item

Abstract

Background. The disadvantage of the known methods of analysis and planning of hindfoot deformities in the sagittal plaBackground. Long bone deformity planning is well established. However, there are not well described methods of analysis and planning of hindfoot deformities in the sagittal plane. Such planning is made even more difficult with concomitant deformation of the midfoot and/or ankle contracture or malpositioned arthrodesis. The aim of our study was to develop a universal method of analysis and planning of the calcaneus correction, based on the normally derived reference lines and angles.

Methods. We analyzed 65 standing lateral foot films in normal adults, 23-54 years old were analyzed. We drew the talus joint line (points “a” and “b” – Line 1). We drew a second line, (Line 2) the calcaneal line, which starts at the back of the calcaneal tuberosity (point “d”), drawn perpendicular to a line from top to bottom of the calcaneal tuberosity. The intersection of the calcaneal line and the talar joint line form point (c) anteriorly. We measured lines ab, ac and cd, and their ratios: ac/ab, and cd/ab.

Results. Talar joint line (Line 1) and calcaneal line (Line 2) intersect at a point (c), forming an angle 15.2° (±3.4°). The ratio ac/ab = 2.56 (± 1.1). The ratio cd/ab = 4.59 (±1.0). These ratios are constants for calculating the idealized joint lines for deformity planning. For deformity cases, draw Line 1, the talar joint line ab. Extend that line anteriorly to (c), which is a distance ab×2.56 from point (a). From (c), draw an idealized calcaneal line, Line-2, at an angle 15° to Line 1. Place (d) on this line, at a distance ab×4.59 from point (c). Next, draw the deformed calcaneal line (Line 3) and point (d1 ) where it exits the calcaneal tuberosity. Use the same technique and landmarks as for drawing the normal calcaneal line. The intersection of Lines 2 and 3 is the apex of the deformity. Rotate the piece containing Line 3 around this apex, until it is collinear with Line 2, and (d) is coincident with (d1 ).

Conclusions. We describe the normal sagittal plane relationships between the hindfoot (calcaneus – talus). This normative data is used for planning sagittal plane hindfoot deformity corrections. It can be used for hindfoot deformities analysis and correction planning. It is independent of ankle joint equinus or malpositioned ankle arthrodesis, which can be considered as separate deformities.

About the authors

L. N. Solomin

Vreden Russian Research Institute of Traumatology and Orthopedics;
Saint-Petersburg State University

Author for correspondence.
Email: solomin.leonid@gmail.com
Leonid N. Solomin – Dr. Sci. (Med.), Professor, Head of Functional Group of External Fixation of Vreden Russian Research Institute of Traumatology and Orthopedics; Professor of the Surgery Chair Medical Faculty of St. Petersburg State University Russian Federation

К. A. Ukhanov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru
Konstantin А. Ukhanov – Doctor of Admission Department Russian Federation

E. P. Sorokin

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru
Evgeniy P. Sorokin – Cand. Sci. (Med.), Researcher Russian Federation

J. E. Herzenberg

Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore

Email: fake@neicon.ru

John E. Herzenberg – MD, Director of Rubin Institute for Advanced Orthopedics

2401 West Belvedere Avenue Baltimore, Maryland, 21215

United States

References

  1. Ген Г.Е. Оперативное лечение паралитической пяточной стопы с применением компрессионно-корригирующего аппарата [Автореф. дис. … кандидат медицинских наук]. Симферополь, 1968. 21 с.
  2. Голубев Г.Ш., Дубинский А.В. Сравнительная оценка результатов оперативного лечения пациентов с импрессионными переломами пяточной кости. Травматология и ортопедия России. 2013;(2):63-71.
  3. Исмайлов Г.Р., Самусенко Д.В., Дьячкова Г.В. Расчет приемов реконструкции заднего отдела стопы. Гений ортопедии. 2001;(4):81-84.
  4. Каленский В.О., Кононова К.Ю., Глухов Д.А., Иванов П.А., Бердюгин К.А., Челноков А.Н. Внутрикостный остеосинтез как новая опция в лечении переломов пяточной кости. Травматология и ортопедия России. 2015;(4):79-85.
  5. Сапоговский А.В., Кенис В.М. Клиническая диагностика ригидных форм планов-вальгусных деформаций стоп у детей. Травматология и ортопедия России. 2015;(4):46-51.
  6. Соломин Л.Н., Уханов К.А., Машков В.М., Глузман М.И. Определение оптимальных компоновок основанного на компьютерной навигации аппарата Орто-СУВ для коррекции сложных деформаций среднего и заднего отделов стопы. Травматология и ортопедия России. 2014;(1):72-79.
  7. Яременко Д.А., Ефименко В.И., Ефимов Р.В. Рентгенологическое исследование в оценке анатомофункционального состояния стопы. Травматология и ортопедия России. 2004;(1):16-20.
  8. David V., Stephens T.J., Kindl R., Ang A., Tay W.H., Asaid R., McCullough K. Calcaneotalar ratio: a new concept in the estimation of the length of the calcaneus. J Foot Ankle Surg. 2015;54(3):370-372. doi: 10.1053/j.jfas.2014.08.008.
  9. DeVries J.G., Scharer B.J. Hindfoot Deformity Corrected With Double Versus Triple Arthrodesis: Radiographic Comparison. Foot Ankle Surg. 2015;4(3):424-427. doi: 10.1053/j.jfas.2014.09.020.
  10. Gonzalez T.A., Enrlichman L.K., Macaulay A.A., Gitajn I.L., Toussaint R.J., Zurakowski D., Kwon J.Y. Determining Measurement Error for Bohler’s Angle and the Effect of X-Ray Obliquity on Accuracy. Foot Ankle Spec. 2016;9(5):409-416. doi: 10.1177/1938640016656236.
  11. Harnroongroj T., Chuckpaiwong B., Angthong C., Nanakorn P., Sudjai N., Harnroongroj T. Displaced articular calcaneus fractures: Classification and fracture scores: a preliminary study. J Med Assoc Thai. 2012;95(3):366-377.
  12. Harnroongroj T., Tangmanasakul A., Choursamran N., Sudjai N., Harnroongroj T. Measurement technique of calcaneal varus from axial view radiograph. Indian J Orthop. 2015;49(2):223-226. doi: 10.4103/0019-5413.152489.
  13. Koval K., Zuckerman J. Handbook of fractures. 3rd ed., Philadelphia: Lippincott Williams and Wilkins; 2006. 440 p.
  14. Lamm B.M., Paley D. Deformity correction planning for hindfoot, ankle, and lower limb. Clin Podiatr Med Surg. 2004;21(3):305-326.
  15. Lamm B.M., Stasko P.A., Gesheff M.G., Bhave A. Normal Foot and Ankle Radiographic Angles, Measurements, and Reference Points. J Foot Ankle Surg. 2016;55(5):991-998. doi: 10.1053/j.jfas.2016.05.005.
  16. Matherne T.H., Tivorsak T., Monu J.U. Calcaneal fractures: what the surgeon needs to know. Curr Probl Diagn Radiol. 2007;36(1):1-10.
  17. Paley D. Principles of deformity correction. New York : Springer-Verlag; 2005. 806 p.
  18. Rammelt S., Zwipp H. Calcaneus fractures: facts, controversies and recent developments. Injury. 2004;35(5):443-461.
  19. Reilingh M.L., Beimers L., Tuijthof G.J., Stufkens S.A., Maas M., van Dijk C.N. Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view. Skeletal Radiol. 2010;39(11):1103-1108. doi: 10.1007/s00256-009-0857-9.
  20. Steel M.W. III, Johnson K.A., DeWitz M.A, Ilstrup D.M. Radiographic measurements of the normal adult foot. Foot Ankle Int. 1980;1(3):151-158.
  21. Su Y., Chen W., Zhang T., Wu X., Wu Z., Zhang Y. Bohler’s angle’s role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study. BMC Surgery. 2013;13(1):40.
  22. Willmott H., Stanton J., Southgate C. Böhler’s angle – What is normal in the uninjured British population? Foot Ankle Surg. 2012;18(3):187-189. doi: 10.1016/j.fas.2011.10.005
  23. Zhang T., Chen W., Su Y., Wang H., Zhang Y. Does axial view still play an important role in dealing with calcaneal fractures? BMC Surg. 2015;15:19. doi: 10.1186/s12893-015-0004-6.
  24. Zhang X.B., Wu H., Zhang L.G., Zhao J.T., Zhang Y.Z. Calcaneal varus angle change in normal calcaneus: a threedimensional finite element analysis. Med Biol Eng Comput. 2017;55(3):429-437. doi: 10.1007/s11517-016-1527-4.

Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies