Baylor University Medical Center, Dallas, TX, USA.
Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Int. 2024 May;45(5):517-525. doi: 10.1177/10711007241231230. Epub 2024 Mar 6.
Establishing a surgical plan for ankle deformities necessitates a comprehensive understanding of the deforming forces involved, and the morphology of the ankle deformity plays an important role as well. Valgus tibiotalar tilt development has mostly been described in patients with a low medial longitudinal arch, as seen in progressive collapsing foot deformity (PCFD). However, some valgus ankles demonstrate no radiographic evidence of a collapsed medial arch. This study aims to investigate whether there are differences in the radiographic morphology of valgus ankle deformities between patients with and without a low medial longitudinal arch to explore if they have different etiologies.
We retrospectively reviewed patients who underwent surgical treatment for asymmetric valgus ankle deformity at our institution between 2017 and 2021. Patients with a valgus tibiotalar tilt (TT) greater than 4 degrees and Meary angle greater than 30 degrees (mean: 38.9) were included in the PCFD group (n = 29). The non-PCFD group (n = 24) with TT greater than 4 degrees and Meary angle less than 4 degrees (mean: 0.3) was also established. In the weightbearing ankle anteroposterior view, the TT and medial distal tibial angle were measured. Additionally, to assess the mediolateral position of the talus, the talar center migration (TCM) and lateral talar dome-plafond distance (LTD-P) ratio in the coronal plane were measured. In weightbearing computed tomography (WBCT), the degree of axial plane talocalcaneal subluxation and the prevalence of sinus tarsi bony impingement were assessed. Intergroup comparison was conducted.
Both groups demonstrated a similar degree of TT, with a mean of 11.6 degrees in the PCFD group and 13.7 degrees in the non-PCFD group ( = .2330). However, the PCFD group showed a significantly greater TCM and LTD-P ratio compared with those of the non-PCFD group ( < .0001), indicating that PCFD patients have a more medially translated talus in ankle anteroposterior radiographs. WBCT showed that the PCFD group on average had 18 degrees greater axial plane talocalcaneal subluxation ( < .0001) and 52% higher prevalence of sinus tarsi bony impingement ( = .0002) compared with the non-PCFD group.
This study suggests that valgus ankles may exhibit different radiographic morphologies depending on the status of the longitudinal arch. Valgus ankles in PCFD patients tend to have a more medially translated talus. This finding may suggest the presence of different deforming forces between the 2 groups and may indicate the need for different treatment strategies to address talar tilt.
Level III, case-control.
制定踝关节畸形的手术方案需要全面了解涉及的变形力，踝关节畸形的形态也很重要。在患有低内侧纵弓的患者中，主要描述了距骨下胫腓倾斜（TT）的发展，如进行性塌陷性足部畸形（PCFD）所见。然而，一些外翻踝关节没有内侧弓塌陷的影像学证据。本研究旨在探讨有无低内侧纵弓的外翻踝关节畸形患者在影像学形态上是否存在差异，以探讨它们是否有不同的病因。
我们回顾性分析了 2017 年至 2021 年期间在我院接受不对称外翻踝关节畸形手术治疗的患者。我们将 TT 大于 4 度和 Meary 角大于 30 度（平均：38.9）的患者纳入 PCFD 组（n=29）。我们还建立了 TT 大于 4 度和 Meary 角小于 4 度（平均：0.3）的非 PCFD 组（n=24）。在负重踝关节前后位片上测量 TT 和内侧胫骨远端角。此外，为了评估距骨的内外侧位置，还测量了冠状面距骨中心迁移（TCM）和外侧距骨穹顶-跟骨底面距离（LTD-P）比值。在负重 CT（WBCT）上，评估轴向平面距跟骨半脱位的程度和跗骨窦骨撞击的发生率。进行组间比较。
两组 TT 程度相似，PCFD 组平均为 11.6 度，非 PCFD 组为 13.7 度（ = .2330）。然而，与非 PCFD 组相比，PCFD 组的 TCM 和 LTD-P 比值明显更大（ < .0001），表明 PCFD 患者在踝关节前后位 X 光片中距骨更向内侧移位。WBCT 显示，与非 PCFD 组相比，PCFD 组平均轴向平面距跟骨半脱位增加 18 度（ < .0001），跗骨窦骨撞击发生率高 52%（ = .0002）。
本研究表明，外翻踝关节可能根据纵弓的状态表现出不同的影像学形态。PCFD 患者的外翻踝关节倾向于距骨更向内侧移位。这一发现可能表明两组之间存在不同的变形力，并可能表明需要不同的治疗策略来解决距骨倾斜问题。
三级，病例对照。
