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Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques

  • Musculoskeletal
  • Published:
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Abstract

Objective

To investigate the ability of coronal non-weight-bearing MR images to discriminate between normal and abnormal hindfoot alignment.

Methods

Three different measurement techniques (calcaneal axis, medial/lateral calcaneal contour) based on weight-bearing hindfoot alignment radiographs were applied in 49 patients (mean, 48 years; range 21–76 years). Three groups of subjects were enrolled: (1) normal hindfoot alignment (0°–10° valgus); (2) abnormal valgus (>10°); (3) any degree of varus hindfoot alignment. Hindfoot alignment was then measured on coronal MR images using four different measurement techniques (calcaneal axis, medial/lateral calcaneal contour, sustentaculum tangent). ROC analysis was performed to find the MR measurement with the greatest sensitivity and specificity for discrimination between normal and abnormal hindfoot alignment.

Results

The most accurate measurement on MR images to detect abnormal hindfoot valgus was the one using the medial calcaneal contour, reaching a sensitivity/specificity of 86 %/75 % using a cutoff value of >11° valgus.

The most accurate measurement on MR images to detect abnormal hindfoot varus was the sustentaculum tangent, reaching a sensitivity/specificity of 91 %/71 % using a cutoff value of <12° valgus.

Conclusion

It is possible to suspect abnormal hindfoot alignment on coronal non-weight-bearing MR images.

Key Points

• Abnormal hindfoot alignment can be identified on coronal non-weight-bearing MR images.

• The sustentaculum tangent was the best predictor of an abnormally varus hindfoot.

• The medial calcaneal contour was the best predictor of a valgus hindfoot.

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References

  1. Gibson V, Prieskorn D (2007) The valgus ankle. Foot Ankle Clin 12:15–27

    Article  PubMed  Google Scholar 

  2. Mendicino RW, Catanzariti AR, Reeves CL, King GL (2005) A systematic approach to evaluation of the rearfoot, ankle, and leg in reconstructive surgery. J Am Podiatr Med Assoc 95:2–12

    PubMed  Google Scholar 

  3. Menz HB (1995) Clinical hindfoot measurement: a critical review of the literature. Foot 5:57–64

    Article  Google Scholar 

  4. Strash WW, Berardo P (2004) Radiographic assessment of the hindfoot and ankle. Clin Podiatr Med Surg 21:295–304

    Article  PubMed  Google Scholar 

  5. Coughlin MJ, Mann RA, Saltzman CL (2007) Surgery of the foot and ankle. Mosby, Philadelphia

    Google Scholar 

  6. Van Bergeyk AB, Younger A, Carson B (2002) CT analysis of hindfoot alignment in chronic lateral ankle instability. Foot Ankle Int 23:37–42

    PubMed  Google Scholar 

  7. Cobey JC (1976) Posterior roentgenogram of the foot. Clin Orthop Relat Res 118:202–207

    PubMed  Google Scholar 

  8. Reilingh ML, Beimers L, Tuijthof GJ, Stufkens SA, Maas M, van Dijk CN (2010) Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view. Skeletal Radiol 39:1103–1108

    Article  PubMed  Google Scholar 

  9. Buck FM, Hoffmann A, Mamisch N, Espinosa N, Resnick D, Hodler J (2011) Hindfoot alignment measurements: rotation-stability of measurement techniques on hindfoot alignment view and long axial view radiographs. AJR Am J Roentgenol 197:578–582

    Article  PubMed  Google Scholar 

  10. Donovan A, Rosenberg ZS (2009) Extraarticular lateral hindfoot impingement with posterior tibial tendon tear: MRI correlation. AJR Am J Roentgenol 193:672–678

    Article  PubMed  Google Scholar 

  11. Saltzman CL, El-Khoury GY (1995) The hindfoot alignment view. Foot Ankle Int 16:572–576

    Article  PubMed  CAS  Google Scholar 

  12. Seltzer SE, Weissman BN, Braunstein EM, Adams DF, Thomas WH (1984) Computed tomography of the hindfoot. J Comput Assist Tomogr 8:488–497

    Article  PubMed  CAS  Google Scholar 

  13. Tanaka Y, Takakura Y, Hayashi K, Taniguchi A, Kumai T, Sugimoto K (2006) Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Br 88:909–913

    Article  PubMed  CAS  Google Scholar 

  14. Takakura Y, Tanaka Y, Kumai T, Tamai S (1995) Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg Br 77:50–54

    PubMed  CAS  Google Scholar 

  15. Pagenstert GI, Hintermann B, Barg A, Leumann A, Valderrabano V (2007) Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res 462:156–168

    Article  PubMed  Google Scholar 

  16. Knupp M, Stufkens SA, Bolliger L, Barg A, Hintermann B (2011) Classification and treatment of supramalleolar deformities. Foot Ankle Int 32:1023–1031

    Article  PubMed  Google Scholar 

  17. Sutter R, Pfirrmann CW, Espinosa N, Buck FM (2012) Three-dimensional hindfoot alignment measurements based on biplanar radiographs: comparison with standard radiographic measurements. Skeletal Radiol Nov 20. [Epub ahead of print]

  18. Robinson I, Dyson R, Halson-Brown S (2001) Reliability of clinical and radiographic measurement of rearfoot alignment in a patient population. Foot 11:2–9

    Article  Google Scholar 

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Authors and Affiliations

  1. Radiology, University Hospital Balgrist & University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland

    Florian M. Buck, Adrienne Hoffmann, Nadja Mamisch-Saupe & Juerg Hodler

  2. Department of Orthopaedic Surgery, University Hospital Balgrist & University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland

    Mazda Farshad & Norman Espinosa

  3. Department of Radiology, University of California San Diego, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA

    Donald Resnick

Authors
  1. Florian M. Buck
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  2. Adrienne Hoffmann
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  3. Nadja Mamisch-Saupe
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  4. Mazda Farshad
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  5. Donald Resnick
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  6. Norman Espinosa
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  7. Juerg Hodler
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Correspondence to Florian M. Buck.

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Buck, F.M., Hoffmann, A., Mamisch-Saupe, N. et al. Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques. Eur Radiol 23, 2594–2601 (2013). https://doi.org/10.1007/s00330-013-2839-5

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  • DOI: https://doi.org/10.1007/s00330-013-2839-5

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