Reliability and Relevance of Radiographic Measures of Metatarsus Primus Elevatus and Arch Alignment in Individuals with Midfoot Arthritis and Controls

2013 ◽  
Vol 103 (5) ◽  
pp. 347-354 ◽  
Author(s):  
Smita Rao ◽  
Katie Bell
Keyword(s):  
Inclination Angle ◽  
Intraclass Correlation ◽  
Positive Association ◽  
Group Differences ◽  
Control Group ◽  
Arch Height ◽  
First Metatarsal ◽  
Compressive Stresses ◽  
Metatarsal Angle ◽  
The Relationship

Background: Low arch alignment and metatarsus primus elevatus (MPE) have been postulated to increase dorsal compressive stresses in the joints of the medial column of the foot and to contribute to the development of degenerative changes. The primary purposes of this study were 1) to examine the relationship between radiographic measures of arch alignment and MPE and 2) to assess arch alignment and MPE in individuals with midfoot arthritis and in asymptomatic controls. The secondary aim was to examine the reliability of radiographic measures of arch alignment and MPE. Methods: Radiographic measures of arch height and MPE were quantified on 28 individuals with midfoot arthritis and 22 individuals in a control group. Reliability was assessed using the intraclass correlation coefficient (ICC). The Pearson product moment correlation (r) was used to assess the relationship between arch alignment and MPE. Between-group differences were assessed using a two-sample t test (α = 0.05). Results: Good to excellent reliability was noted for measures of arch height (ICC[2,3] = 0.919–0.994) as well as MPE (ICC[2,3] = 0.891–0.882). A modest positive association was noted between normalized cortical elevation and normalized navicular height (r = 0.274, P = .030) and calcaneal inclination angle (r = 0.263, P = .035). Individuals with midfoot arthritis demonstrated lower arch alignment, reflected in a significantly higher calcaneal–first metatarsal angle (P = .002), lower calcaneal inclination angle (P = .004), and lower normalized navicular height (P < .001) compared with controls. No evidence was found to support between-group differences in lateral intermetatarsal angle (P = .495) and normalized cortical elevation (P = .146). Conclusions: These findings provide objective data establishing the reliability of measures of MPE and arch alignment and their potential clinical significance. (J Am Podiatr Med Assoc 103(5): 347–354, 2013)

Effect of Proximal Dome and Distal Chevron Osteotomies on Plantar Pressures and Radiographic and Functional Outcomes in Hallux Valgus Surgery: A Retrospective Analysis

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Kadir Ilker Yildiz ◽  
Abdulhamit Misir ◽  
Turan Bilge Kizkapan ◽  
Mustafa Cukurlu ◽  
Canan Gonen Aydin
Keyword(s):  
Hallux Valgus ◽  
Inclination Angle ◽  
Plantar Pressure ◽  
Functional Outcomes ◽  
First Metatarsal ◽  
Pressure Point ◽  
Radiographic Outcomes ◽  
Metatarsal Angle ◽  
Dome Osteotomy ◽  
Pressure Changes

Background No detailed comparative studies have been performed regarding plantar pressure changes between proximal dome and distal chevron osteotomies. This study aimed to compare radiographic and plantar pressure changes after distal chevron and proximal dome osteotomies and to investigate the effect of radiographic and plantar pressure changes on clinical outcomes. Methods This study included 26 and 22 patients who underwent distal chevron and proximal dome osteotomies, respectively. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scores were used to evaluate pain and functional outcomes. Hallux valgus angle, intermetatarsal angle, talar–first metatarsal angle, and calcaneal inclination angle were measured in the evaluation of radiographic outcomes. Preoperative and postoperative plantar pressure changes were evaluated. Results There were no statistically significant differences between the two groups in age, body mass index, or AOFAS forefoot and VAS scores. In the proximal dome group, the pressure measurement showed significant lateralization of the maximal anterior pressure point in the forefoot (P < .001). In addition, the postoperative calcaneal inclination angle was significantly lower (P = .004) and the talar–first metatarsal angle was significantly higher (P < .001) in the proximal dome group. Postoperative transfer metatarsalgia was observed in one patient (3.8%) in the distal chevron group and five (22.7%) in the proximal dome group (P < .05). Conclusions Proximal dome osteotomy led to more lateralization of the maximum anterior pressure point, decreased calcaneal inclination angle and first metatarsal elevation, and related higher transfer metatarsalgia.

scholarly journals The Positive Association Between Metatarsal Length and Meary’s Angle and Hammertoe Deformity

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0030
Author(s):  
Jesse King ◽  
Chris M. Stauch ◽  
Ryan M. Ridenour ◽  
Umur Aydogan
Keyword(s):  
Average Length ◽  
Articular Surface ◽  
Positive Association ◽  
Lower Extremity Injury ◽  
Control Group ◽  
First Metatarsal ◽  
Diagnosis Codes ◽  
Radiographic Measurements ◽  
Significant Difference ◽  
Icd 10

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Hammertoe deformities are the most common pathology of the forefoot, accounting for up to 48% of all forefoot operations. There is currently limited evidence documenting differences in foot radiographs and radiographic measurements that may represent a predisposition to developing hammertoe deformity. The purpose of this study was to investigate whether patients with hammertoe deformity demonstrate increased radiographic measurements of first, second, or third metatarsal (MT) lengths as well as Meary’s angle compared to a healthy control group. Methods: Following IRB approval, an institutional radiology database was queried from January 2009-2018 for patients with ICD- 9 and ICD-10 diagnosis codes for hammertoe deformity of the 2nd or 3rd phalange. Control cases were selected using diagnosis codes for acute plantar fascial pain in the same timeframe with medical record review to exclude patients with prior lower extremity injury, surgery or pathology. 234 hammertoe and 110 control patients met inclusion and exclusion criteria. Automated 1:1 case-control matching was performed to control for age, sex and laterality. Following matching, the sample size consisted of 80 patients in each cohort. Proximal to distal end-to-end articular surface radiographic lengths were documented for metatarsals and phalanges of the 1st, 2nd and 3rd rays on anteroposterior radiographs. Lateral talar-first metatarsal (Meary’s) angle was measured using weightbearing sagittal radiographs by calculating the angle formed by lines that bisect the talar neck and anatomic neck of the first metatarsal. Results: A total of 160 patients (80 cases and 80 controls) were included in the study. Mean age was 47.7 years among hammertoe cases and 47.5 years among controls (p=0.92). 54 of 80 cases in each group were female. There was a statistically significant increase in the average Meary’s angle among hammertoe patients (5.23 +- 8.60°) compared to controls (2.15 +- 5.96°) (p<0.01). The average length for the 1st, 2nd and 3rd metatarsals were 65.6, 80.0, and 76.7 mm, respectively for the hammertoe patients and 62.8 mm, 76.0 mm, and 73.5 mm among control cases, respectively. For all three metatarsals, this difference was statistically significant (p<0.01; Table 1). There was no statistically significant difference between lengths of the proximal or distal phalanges. Conclusion: Patients with hammertoe deformity were associated with an increased length on the 1st, 2nd and 3rd metatarsals. Also, these patients demonstrated an increased Meary’s angle creating pes planus deformity. These results illustrate the importance of both medial column instability and long metatarsal length in the development of hammertoe deformity. [Table: see text]

scholarly journals Roentgenographs Study of Cavus Foot Deformity in Friedreich Ataxia Patients: Preliminary Report

1982 ◽  
Vol 9 (2) ◽  
pp. 113-117 ◽  
Author(s):  
P. Allard ◽  
J.P. Sirois ◽  
P.S. Thiry ◽  
G. Geoffroy ◽  
M. Duhaime
Keyword(s):  
Inclination Angle ◽  
Weight Bearing ◽  
Friedreich Ataxia ◽  
Quantitative Description ◽  
Foot Deformity ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Cavus Foot ◽  
Three Stages

SUMMARY:The preliminary results based on a three year retrospective study in cavus foot deformity of forty-four Friedreich ataxia patients regularly seen at the Neuromuscular Disease Clinic of Sainte-Justine Hospital have been presented. An accurate “weight-bearing” foot stereoradiographic technique has been recently developed by our group. Since the follow-up period with this device is not sufficient to provide statistical information, the conventional non-weight bearing technique has been utilized in this study to enable a possible comparison between the radiographs of ambulant and non-ambulant patients. Due to the present technique, the results of this study must be interpreted with caution.For 132 pairs of radiographs, 28 parameters have been analyzed. Four of these, namely the calcaneal inclination angle, the first metatarsal inclination angle, the inferior cortex of calcaneus-first metatarsal angle and the first-fifth metatarsals angle, were of particular interest. From these parameters, a preliminary quantitative description of cavus foot deformity in Friedreich’s ataxia has been attempted. Three stages of evolution have been tentatively identified for this type of neurological disorder.

scholarly journals The Role of Cavovarus Deformity in the Pathogenesis of Peroneal Tendon Tears

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0009
Author(s):  
Shannon F. Alejandro ◽  
Akira Taniguchi ◽  
Justin M. Kane ◽  
Samuel E. Ford ◽  
Daniel J. Scott ◽  
...  
Keyword(s):  
Matched Control ◽  
Objective Measures ◽  
Control Group ◽  
Peroneal Tendon ◽  
Significance Level ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Cavus Foot ◽  
Tendon Tears

Category: Other; Sports Introduction/Purpose: While it is a commonly accepted principle peroneal tendon (PT) tears are associated with cavovarus deformity, this is the first study that both quantifies deformity in patients with surgically proven tears using sophisticated and reproducible methods to compare radiographic measurements to a matched control group. Understanding of the anatomy and mechanism of injury affecting the PTs has led to greater recognition of PT tears as an important cause of lateral sided foot and ankle pain. The literature reports a presumed correlation between the cavus foot and PT tears. Little data exist quantifying the correlation between PT tears and the alignment of the foot. We hypothesize the cavovarus foot applies stress over the lateral border of the foot leading to degenerative changes in PTs. Methods: A cohort of 252 consecutive patients operatively treated for peroneal tendon tears (PT) were compared to an age- and sex- matched control (C) group of 104 outpatients treated for isolated forefoot problems. Calcaneal pitch, calcaneal - first metatarsal, talometatarsal, and talocalcaneal angles were compared on standing lateral radiographs. Talometatarsal and talocalcaneal angles, and talonavicular coverage, were compared on standing anteroposterior radiographs. Published radiographic criteria were used to determine cavovarus. ANOVA analysis detected statistically significant differences between patients and controls and a subsequent Tukey-Kramer test compared the control group with each type of PT tear. An a prioripower analysis was performed to calculate the minimum sample size in each cohort to detect a 90% effect size for a significance level of p<0.05. Results: Radiographic cavovarus was found in 9.4% (74/252) of PT group, and 6.7% (7/104) in controls. On lateral radiographs a significant greater calcaneal pitch (p=0.0001), and significant smaller calcaneal-first metatarsal angle (p=0.0084) was noted with PT tears (p=0.0001). On anteroposterior radiographs a significant smaller talometatarsal angle (p=0.0001) and talonavicular coverage (p=0.0001) were noted in PT tears. AP talocalcaneal and lateral talometatarsal and talocalcaneal angles were not correlated with PT tears. Patients treated for PT tears, isolated peroneus brevis tears (PB) accounted for 67.9% (171/252), isolated peroneus longus (PL) tendon tears were 7.5% (19/252), PB and PL tears accounted for 17.5% (44/252). A smaller talometatarsal angle on the AP was associated with PL (0.0098) and combined PB and PL tears (<0.0001) but not PB tears alone (0.1162). Conclusion: The correlation between cavovarus and peroneal pathology in the literature is highly anecdotal. Few studies report objective measures. This is the first study to our knowledge comparing nature and severity of cavovarus according to location of peroneal tear. This study proves and quantifies objective measures of cavovarus that correlate with peroneal tendon tears, when compared to a cohort of matched controls.

Validation of the Talar–Second Metatarsal Angle as a Standard Measurement for Radiographic Evaluation

2011 ◽  
Vol 101 (6) ◽  
pp. 475-483 ◽  
Author(s):  
Michael E. Graham ◽  
Avanthi Chikka ◽  
Paul C. Jones
Keyword(s):  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Radiographic Evaluation ◽  
Foot Deformities ◽  
Accurate Information ◽  
Intraclass Correlation Coefficients ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Second Metatarsal ◽  
Angular Measurements

Background: Radiographs provide valuable information for assessing osseous foot deformities and aid in accurate diagnosis. The radiographic angular measurements can be used to establish a relationship between the forefoot and the hindfoot that will present valuable information about normal versus pathologic alignment of the foot. The talar–first metatarsal (T1M) angle is frequently used as one of these angles in this capacity; however, there are limitations to the anteroposterior T1M angle. We present a more consistent, reproducible, and accurate measurement for determining foot abnormalities in the transverse plane using the T2M angle instead of the T1M angle. Methods: Seventy feet in 35 participants (12 men and 23 women) were considered for this study. Individuals were selected on the basis of the established inclusion and exclusion criteria. Anteroposterior radiographs were taken in the angle and base of gait, the neutral calcaneal stance position (NCSP), and the resting calcaneal stance position (RCSP). Three observers measured these angles using three different methods. Results: The mean ± SD T2M angle was 2.95° ± 7.16° in NCSP and 18.61° ± 7.21° in RCSP. No significant differences were found among the measurements made by the three observers using slightly varying procedures in NCSP and RCSP (P &gt; .05). The intraclass correlation coefficients among the measurements were 0.905 in NCSP and 0.937 in RCSP. Bland-Altman plots showed very good agreement between the measurements made by the three observers. Conclusions: The anteroposterior T2M angle gives a consistent and reproducible measurement that provides accurate information about foot alignment. (J Am Podiatr Med Assoc 101(6): 475–483, 2011)

scholarly journals Validity of Two-Dimensional Static Footprint in Medial Longitudinal Arch Evaluation and the Characteristics of Athletes’ Footprints

2020 ◽  
Author(s):  
Lingli Zhang ◽  
Dali Yu ◽  
Le Lei ◽  
Yuanwu Gao ◽  
Junjie Dong ◽  
...  
Keyword(s):  
College Students ◽  
Inclination Angle ◽  
Medial Longitudinal Arch ◽  
Two Dimensional ◽  
Important Indicator ◽  
First Metatarsal ◽  
Longitudinal Arch ◽  
Metatarsal Angle ◽  
The Right ◽  
High Level

AbstractBackgroundWe aimed to explore the validity of two-dimensional static footprint analysis in medial longitudinal arch evaluation as well as the characteristics of athletes’ footprints to provide a basis for the evaluation and selection of athletes.MethodsExperiment One: Twenty-nine high level athletes (runners and jumpers) and forty normal college students were selected. Based on the X-ray photos taken of the medial foot, we measured the calcaneal inclination angle, the calcaneal–first metatarsal angle and the ratio of height to length of the medial longitudinal arch. We collected indicators of two-dimensional static footprints. Experiment Two: 106 high level athletes (runners and jumpers) and 104 normal college students were selected. We also collected indicators of two-dimensional static footprints.ResultsThe average measuring the Interclass Correlation Efficient (ICC) of calcaneal inclination angle, calcaneal–first metatarsal angle, the ratio of height to length of the medial longitudinal arch, the width of ball, arch and heel, the length of footprint and each toe, Chippaux-Smirak Index (CSI) and Staheli Index (SAI) were higher than 0.800. Regardless of athletes or college students, male or female, the correlation between CSI, SAI and calcaneal inclination angle, calcaneal–first metatarsal angle, the ratio of height to length of the medial longitudinal arch was statistically significant (P<0.05). College students’ CSI of the right foot is significantly higher than that of the left foot regardless of gender (P<0.05).ConclusionsWe prove the qualification of CSI and SAI in medial longitudinal arch evaluation and explain that the relative height of medial longitudinal arch is an important indicator in track and field.

Ego Depletion in the Relationship Between Behavior Inhibition and Loss Aversion

2019 ◽  
Vol 47 (4) ◽  
pp. 1-12
Author(s):  
Wenbin Gao ◽  
Yue Zhou ◽  
Ting Tao ◽  
Yan Yu ◽  
Ligang Wang
Keyword(s):  
Decision Making ◽  
Loss Aversion ◽  
Positive Association ◽  
Framing Effect ◽  
Ego Depletion ◽  
Control Group ◽  
Behavioral Inhibition System ◽  
Decision Making Behavior ◽  
Behavior Inhibition ◽  
The Relationship

We examined the associations between ego depletion, personality, and decision-making behavior, and investigated whether ego depletion enhances the relationship between the behavioral inhibition system (BIS) and loss aversion. Participants (N = 70) were randomly assigned to depletion or control conditions, completed a financial decision-making task to test the framing effect, and responded to a measure of BIS. The results showed a framing effect in the decision-making task that was not weakened by ego depletion. However, participants in the depleted (vs. control) group, regardless of framing, showed more loss aversion in the decision-making task. Further, ego depletion enhanced the positive association between the BIS and framing effects, which means that ego depletion moderated the effect of the BIS on loss aversion. Thus, ego depletion did not directly contribute to more conservative or impulsive decision making, but it did lead individuals to act more in line with their habits or characteristics. Implications of these findings are discussed.

scholarly journals Is It Possible to Define Reference Values for Radiographic Parameters Evaluating Juvenile Flatfoot Deformity? A Case-Control Study

2020 ◽  
Author(s):  
Johannes Hamel ◽  
Hubert Hörterer ◽  
Norbert Harrasser
Keyword(s):  
Reference Values ◽  
Control Group ◽  
Roc Curve Analysis ◽  
First Metatarsal ◽  
Radiographic Parameters ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Group A ◽  
Group B ◽  
Control Study

Abstract BackgroundNumerous radiographic parameters are described to evaluate juvenile flexible flatfeet. Reference values for these measurements are based on few studies. The purpose of this study was to determine boundary values among the most widely used radiographic measurements to evaluate juvenile flatfeet.MethodsTwenty-two patients with normal hind-, midfoot configuration (group A: control group; 22 feet, mean age: 12,1 years) and 19 patients with flatfoot deformity (group B: study group; 22 feet, mean age: 12,4 years) were retrospectively analyzed. Nine radiographic parameters were measured (Talocalcaneal-angles, Calcaneal-pitch-angle, Costa-Bartani-angle, Talo-metatarsal-I-angles, Talo-first-metatarsal-base-angle, Talo-navicular-coverage, Calcaneus-fifth-metatarsal-angle). ROC curve analysis was used to calculate optimal differentiating thresholds of each parameter.ResultsFour out of nine parameters (TC-dp, TC-lat, Calc-MTV, Calc-P) were not statistically different between the groups and their ability to distinct between normal foot and flatfoot was low (AUC values= 0,660 - 0,819). Calculation of reference values for these parameters was not performed due to threshold ranges between the groups of >10°. Reference values could be defined only for three parameters: TMTInd >(-)31°, TMTIB >(-)7,5°, TMT-lat >(-)13,5°. The TMTInd was shown to be a very reliable and valid combination of two measurements (TMTIB and TMT-lat) in the differentiation of normal feet and flatfeet (AUC=0,998).ConclusionThe calculation of reference values for established radiographic parameters used to evaluate juvenile flatfeet is difficult for most parameters. The TMTInd as a combination of TMTIB and TMT-lat has been shown to be reliable and valuable to distinct normal feet from flatfeet.

RAGE and Aβ Immunoglobulins: Relation to Alzheimer’s disease-related cognitive function

2010 ◽  
Vol 16 (4) ◽  
pp. 672-678 ◽  
Author(s):  
MEGHAN B. MITCHELL ◽  
JERRY J. BUCCAFUSCO ◽  
ROSANN F. SCHADE ◽  
SCOTT J. WEBSTER ◽  
SHYAMALA MRUTHINTI ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Group Differences ◽  
Control Group ◽  
Cognitive Differences ◽  
Glycation End Products ◽  
Amyloid Aβ ◽  
Language Measures ◽  
The Relationship

AbstractThe immunoglobulins (IgGs) for beta amyloid (Aβ) and receptors for the advanced glycation end products (RAGE) have previously been shown to be related to memory and language measures in a mixed neurological sample of older adults. In this study, we examined group differences in Aβ and RAGE IgGs, as well as the relationship between both IgGs and cognitive performance in nondiabetic older adults with normal cognition, mild cognitive impairment (MCI), and probable Alzheimer’s disease (AD). We found RAGE and Aβ levels to be elevated in some AD participants, leading to significant AD–control group differences. While there was an overall correlation between both IgG levels and global cognition across all three groups, this relationship was largely attributable to group differences in cognition, highlighted by considerable variability within groups in the relationship between IgG levels and cognition. While findings do not support a consistent relationship between cognition and either IgG, further research with larger samples is needed to better characterize cognitive differences between AD participants with high versus low Aβ and RAGE titers. (JINS, 2010, 16, 672–678.)

Association of Cavovarus Foot Alignment With Peroneal Tendon Tears

2021 ◽  
pp. 107110072199034
Author(s):  
Akira Taniguchi ◽  
Shannon F. Alejandro ◽  
Justin M. Kane ◽  
Yahya Daoud ◽  
Yasuhito Tanaka ◽  
...  
Keyword(s):  
Coordinate System ◽  
Control Group ◽  
Peroneal Tendon ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Retrospective Comparison ◽  
Comparative Cohort Study ◽  
Tendon Tears ◽  
Peroneus Brevis

Background Although it is a widely accepted clinical principle that cavovarus deformity predisposes to peroneal tendon problems, there are limited data to support that assumption. This study tested the hypothesis that cavovarus is associated with peroneal tendon tears and evaluated which radiographic measures correlated with that association. Methods: A retrospective comparison of radiographic measures of cavovarus in 234 consecutive patients operatively treated for chronically symptomatic peroneal tendon tears was compared to a matched control group. Measures included calcaneal pitch, anteroposterior (AP) talometatarsal and talocalcaneal angles, and talonavicular coverage angle. A novel coordinate system analyzed midfoot and hindfoot components of cavovarus. Analysis of variance was used to compare cohorts, and a Tukey-Kramer test used to analyze 3 subgroups of brevis and longus tears, and concomitant tears. Results: The distribution of tears was 73% peroneus brevis, 8% longus, and 19% both tendons. Compared with controls, the study group, and subgroups, had multiple measures of increased cavovarus, including greater calcaneal pitch ( P = .0001), decreased AP talo–first metatarsal angle ( P = .0001), and increased talonavicular coverage angle ( P = .0001). Elevated medial longitudinal arch, and rotational changes in the radiographic profiles of the hindfoot were found with the coordinate system described by Yokokura. Conclusion: This study found a statistically significant association of increased cavovarus deformity with peroneal tendon tears, compared to controls. It documented the relative incidence of tears of peroneus brevis, peroneus longus, and concomitant tears in a large surgical series. It demonstrated which simple radiographic angles and complex coordinate measurements of cavovarus deformity were significantly associated with peroneal tendon tears. Level of Evidence: Level III, retrospective comparative cohort study.

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