Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Gait Posture. 2023 Jul;104:116-119. doi: 10.1016/j.gaitpost.2023.06.008. Epub 2023 Jun 16.
For multi-segment foot models, next to a (dorsal) heel marker, further markers are typically placed medially (MCL) and laterally (LCL) on the calcaneus. However, there is a lack of easily identifiable landmarks on the hindfoot limiting the repeatability of measurements. For a more consistent placement of these markers, an improved Hindfoot Alignment Device (HiAD) was developed.
With the HiAD, the position of the MCL and LCL can be individually scaled. Flexible bars allow the adaptation to foot deformities. Three rater placed markers with the HiAD four times on ten typical developed subjects (20 feet). Rigid segment residuals of the hindfoot were calculated and compared with the residuals when using the device of Simon et al. (2006) [12]. The variability of the placement of MCL, LCL and the clinical parameter medial arch were determined. For assessing the inter- and intra-rater reliability, intraclass correlation coefficient (ICC) and the standard error of measurement (SEM) were calculated.
Rigid segment residuals of the hindfoot could be reduced by 70 % by using the HiAD. Largest inter-rater variability in the MCL and LCL placement was found in z-direction with less than 3.2 ± 2.7 mm and 3.8 ± 2.8 mm, respectively. Correspondingly, largest intra-rater variability was 3.4 ± 2.3 mm for LCL and 2.4 ± 1.9 mm for MCL, respectively. Regarding reliability ICC showed good to excellent results for the medial arch (interrater ICC 0.471-0.811).
The application of HiAD to place MCL and LCL appear to be a reliable method with robust marker positions and could be implemented in any multi segment foot model. However, further investigation would be helpful to determine the sensitivity of the marker positions in detecting hindfoot deformities.
对于多节段足部模型，除了（背侧）跟骨标记物外，通常还在跟骨内侧（MCL）和外侧（LCL）放置进一步的标记物。然而，后足缺乏易于识别的标志点，限制了测量的可重复性。为了更一致地放置这些标记物，开发了一种改进的后足对线装置（HiAD）。
使用 HiAD，可以单独调整 MCL 和 LCL 的位置。柔性杆允许适应足部畸形。三位评估者使用 HiAD 四次将标记物放置在十个典型发育的受试者（20 只脚）上。计算后足刚性段残差，并与使用 Simon 等人的装置（2006 年）[12]时的残差进行比较。确定 MCL、LCL 和临床参数内侧弓的放置的可变性。为了评估组内和组间评估者的可靠性，计算了组内相关系数（ICC）和测量标准误差（SEM）。
使用 HiAD 可将后足刚性段残差降低 70%。在 MCL 和 LCL 放置的 z 方向上发现最大的组间变异性，分别为小于 3.2±2.7mm 和 3.8±2.8mm。相应地，LCL 的最大组内变异性为 3.4±2.3mm，而 MCL 的最大组内变异性为 2.4±1.9mm。关于可靠性，内侧弓的 ICC 显示出良好到极好的结果（组间 ICC 0.471-0.811）。
HiAD 用于放置 MCL 和 LCL 的应用似乎是一种可靠的方法，具有稳定的标记位置，可以在任何多节段足部模型中实施。然而，进一步的研究将有助于确定标记位置检测后足畸形的敏感性。
