Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

• Published in: Clinical orthopaedics and related research Vol. 468; no. 12; pp. 3362 - 3370
• Main Authors: Frigg, Arno, Nigg, Benno, Davis, Elysia, Pederson, Beth, Valderrabano, V.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.12.2010; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Ankle Joint - diagnostic imaging; Ankle Joint - physiopathology; Ankle Joint - surgery; Arthrodesis; Biological and medical sciences; Calcaneus - diagnostic imaging; Calcaneus - surgery; Canada; Case-Control Studies; Clinical Research; Conservative Orthopedics; Diseases of the osteoarticular system; Female; Foot and Ankle; Gait; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Pressure; Radiography; Recovery of Function; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Talus - diagnostic imaging; Talus - surgery; Tibia - diagnostic imaging; Tibia - surgery; Time Factors; Treatment Outcome; Tibial Axis; Visual Judgment; Hindfoot Alignment; Varus Position; Ankle Arthrodesis; Ankle; Radiography; Alignment; Ankle joint; Radiodiagnosis; Orthopedics; Exploration; Foot
• ISSN: 0009-921X; 1528-1132; 1528-1132
• DOI: 10.1007/s11999-010-1449-7

Background The Saltzman-el-Khoury hindfoot alignment view (HAV) is considered the gold standard for assessing the axis from hindfoot to tibia. However, it is unclear whether radiographic alignment influences dynamic load distribution during gait. Questions/purposes We evaluated varus-valgus alignment by the HAV and its influence on dynamic load distribution in ankle and tibiotalocalcaneal (TTC) arthrodesis. Patients and Methods We clinically assessed 98 patients (ankle, 56; TTC, 42) with SF-36 and American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual hindfoot alignment, HAV angle, and dynamic pedobarography using a five-step method. For comparison, 70 normal feet were evaluated. Minimum followup was 2 years (average, 4.11 years; range, 2–6 years). Results The mean HAV angle was −0.8° ± 7.8° for ankle and −1.2° ± 6.9° for TTC arthrodesis. The HAV angle correlated with pedobarographic load distribution (r = 0.35–0.53). Radiographic alignment did not influence SF-36 or AOFAS scores; however, load distribution correlated to qualities of these scores. Visual alignment only predicted the corresponding HAV angle in 48%. To reproduce the dynamic load of healthy subjects, HAV angles of 5° to 10° valgus were needed. Conclusions Visual positioning is inadequate to determine intraoperative positioning and resulted in a varus position with a relatively large SD. The HAV should be used to assess the hindfoot alignment correctly. HAV angles of 5° to 10° valgus are needed to reproduce a physiologic gait pattern.