RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound, Seattle, Washington, 98108; School of Medicine, University of Washington, Seattle, Washington, 98195.
J Orthop Res. 2014 Jul;32(7):958-66. doi: 10.1002/jor.22612. Epub 2014 Apr 9.
This study explored three dimensional (3D) talonavicular joint (TNJ) coverage/orientation and bone morphology to reveal parameters that could classify and identify predispositions to cavus and planus feet. 3D models of 65 feet from 40 subjects were generated from computed tomography images classified as pes cavus, neutrally aligned, or asymptomatic/symptomatic pes planus. We calculated the talar and navicular overlap (TNJ coverage). We also measured orientation of the navicular, morphological parameters of the talus and navicular, and angular position of the talar head to body. Pes cavus showed significantly less talonavicular coverage (58 ± 2% talus and 86 ± 2% navicular) compared to asymptomatic pes planus (63 ± 2% and 95 ± 2%) and neutrally aligned feet (98 ± 2% navicular), and significantly more navicular dorsiflexion and adduction relative to the talus (p < 0.0083). The talar head in cavus feet was inverted relative to the body compared to planus feet (p < 0.0083). For symptomatic pes planus, significant abduction was measured for the navicular relative to the talus and the talar head was plantar flexed relative to the body (p < 0.0083). The talar head in planus feet was everted relative to the body compared to neutrally aligned feet. Both intrinsic (bone morphology) and extrinsic (bone position) differences exist in groups of feet described as cavus and planus.
本研究探索了三维(3D)距下关节(TNJ)覆盖/方位和骨骼形态,以揭示可分类和识别高弓足和扁平足倾向的参数。从 CT 图像生成了 40 名受试者的 65 只脚的 3D 模型,这些图像分为高弓足、中立位和无症状/有症状的扁平足。我们计算了距骨和跟骨的重叠(TNJ 覆盖)。我们还测量了跟骨的方位、距骨和跟骨的形态参数以及距骨头部相对于身体的角度位置。与无症状扁平足(63%±2%和 95%±2%)和中立位足(98%±2%)相比,高弓足的距下关节覆盖明显较少(58%±2%距骨和 86%±2%跟骨),跟骨相对于距骨的背屈和内收角度也明显更大(p<0.0083)。与扁平足相比,高弓足的距骨头部相对于身体呈内翻(p<0.0083)。对于有症状的扁平足,与距骨相比,跟骨的外展角度显著增大,距骨头部相对于身体呈跖屈(p<0.0083)。与中立位足相比,扁平足的距骨头部相对于身体呈外翻。高弓足和扁平足的足部群体存在内在(骨骼形态)和外在(骨骼位置)差异。