What is the most reliable radiographic method to evaluate the longitudinal foot arch? Application in subjects with Adolescent Idiopathic Scoliosis.

BACKGROUND

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.

HYPOTHESES

(1) distant and clear anatomical landmarks are needed to draw the foot axes accurately; (2) foot longitudinal arch parameters differ between AIS and controls.

METHODS

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.

RESULTS

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.

DISCUSSION

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.