Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon.
Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon.
Orthop Traumatol Surg Res. 2020 Nov;106(7):1263-1268. doi: 10.1016/j.otsr.2019.11.024. Epub 2020 Feb 5.
The foot arch is known to be altered in subjects with postural malalignment. Foot arch morphology can be studied simultaneously with body's balance by measuring foot radiographic parameters on full-body biplanar x-rays. There is no consensus on which is the most reliable method to use to draw the foot axes. The aim was to determine the most reliable methods to draw the main foot axes and apply these findings in order to study the difference of foot parameters between AIS and control subjects.
(1) distant and clear anatomical landmarks are needed to draw the foot axes accurately; (2) foot longitudinal arch parameters differ between AIS and controls.
Ninety AIS patients and 36 controls have undergone full body biplanar X-rays from which 3D spino-pelvic and postural parameters were collected for each patient. Six radiological foot angles were evaluated on the 2D lateral radiographs: calcaneal pitch (CPA), talar declination (TDA), first metatarsal declination (FMDA), talo-calcaneal (TCA), calcaneal first metatarsal (CFMA) and Meary. Angles were calculated based on three major axes of the foot: talar, calcaneal, and first metatarsal. Two to three methods were used to draw each axis and the reliability of each method was assessed (three operators, 2-times each). Then, differences of the foot parameters between AIS and controls, and determinants of these differences among 3D spino-pelvic and postural parameters were evaluated.
The most reliable methods for drawing the three axes of the foot were those using distant and clear anatomical landmarks on talus, calcaneum and first metatarsal and used for the subsequent analysis. The AIS group showed a significantly lower TDA (22° vs. 24°, p=0.014) and CFMA (141° vs. 144°, p=0.045), and higher FMDA (18° vs. 15°, p=0.008) and Meary's angle (-5° vs. -9°, p=0.005) when compared to controls. Differences were found to be determined mainly by the center of auditory meatus sagittal plumbline.
This is the first study to evaluate the most reliable method to draw foot axes on the lateral radiograph of biplanar X-rays in order to assess radiological foot arch parameters. AIS patients were shown to have more elevated foot arch compared to controls.
已知姿势不正的患者足弓会发生改变。通过对双平面 X 射线的全长身体生物平面成像测量足的放射学参数，可以同时研究足弓形态和身体平衡。目前尚无共识确定绘制足轴最可靠的方法。本研究旨在确定最可靠的方法来绘制主要的足轴，并应用这些发现来研究 AIS 和对照组之间足参数的差异。
（1）需要清晰的远距离解剖学标志来准确地绘制足轴；（2）AIS 和对照组的足纵弓参数不同。
90 例 AIS 患者和 36 例对照组患者接受了全身双平面 X 射线检查，为每位患者采集了三维脊柱骨盆和姿势参数。在二维侧位 X 光片上评估了 6 个放射学足角度：跟骨倾斜角（CPA）、距骨下倾角（TDA）、第一跖骨下倾角（FMDA）、距跟角（TCA）、跟骨第一跖骨角（CFMA）和 Meary 角。角度基于足的三个主要轴：距骨、跟骨和第一跖骨计算。使用了两种或三种方法来绘制每个轴，并评估每种方法的可靠性（三位操作员，每人两次）。然后，评估 AIS 和对照组之间的足参数差异，以及三维脊柱骨盆和姿势参数中这些差异的决定因素。
用于绘制足三轴的最可靠方法是那些使用距骨、跟骨和第一跖骨上的清晰远距离解剖学标志的方法，这些方法用于后续分析。与对照组相比，AIS 组的 TDA（22° vs. 24°，p=0.014）和 CFMA（141° vs. 144°，p=0.045）明显降低，而 FMDA（18° vs. 15°，p=0.008）和 Meary 角（-5° vs. -9°，p=0.005）升高。发现差异主要由听道矢状铅垂线的中心决定。
这是第一项评估双平面 X 射线侧位片上绘制足轴最可靠方法的研究，以评估放射学足弓参数。与对照组相比，AIS 患者的足弓更高。
