CT measurement of range of motion of ankle and subtalar joints following two lateral column lengthening procedures.

BACKGROUND: Lateral column lengthening (LCL) has become an accepted procedure for the operative treatment of the flexible flatfoot deformity. Hindfoot arthrodesis via a calcaneocuboid distraction arthrodesis (CCDA) has been considered a less favourable surgical option than the anterior open wedge calcaneal distraction osteotomy (ACDO), as CCDA has been associated with reduced hindfoot joint motion postoperatively. The ankle and subtalar joint ranges of motion were measured in patients who underwent an ACDO or CCDA procedure for flatfoot deformity. METHODS: CT scanning was performed with the foot in extreme positions in five ACDO and five CCDA patients. A bone segmentation and registration technique for the tibia, talus and calcaneus was applied to the CT images. Finite helical axis (FHA) rotations representing the range of motion of the joints were calculated for the motion between opposite extreme foot positions of the tibia and the calcaneus relative to the talus. RESULTS: The maximum mean FHA rotation of the ankle joint (for extreme dorsiflexion to extreme plantarflexion) after ACDO was 52.2 degrees ± 12.4 degrees and after CCDA 49.0 degrees ± 12.0 degrees. Subtalar joint maximum mean FHA rotation (for extreme eversion to extreme inversion) following ACDO was 22.8 degrees ± 8.6 degrees, and following CCDA 24.4 degrees ± 7.6 degrees. CONCLUSION: An accurate CT-based technique was used to assess the range of motion of the ankle and subtalar joints following two lateral column lengthening procedures for flatfoot deformity. Comparable results with a considerable amount of variance were found for the range of motion following the ACDO and CCDA procedures.

Determination of consistent patterns of range of motion in the ankle joint with a computed tomography stress-test.

BACKGROUND: Measuring the range of motion of the ankle joint can assist in accurate diagnosis of ankle laxity. A computed tomography-based stress-test (3D CT stress-test) was used that determines the three-dimensional position and orientation of tibial, calcaneal and talar bones. The goal was to establish a quantitative database of the normal ranges of motion of the talocrural and subtalar joints. A clinical case on suspected subtalar instability demonstrated the relevance the proposed method. METHODS: The range of motion was measured for the ankle joints in vivo for 20 subjects using the 3D CT stress-test. Motion of the tibia and calcaneus relative to the talus for eight extreme foot positions were described by helical parameters. FINDINGS: High consistency for finite helical axis orientation (n) and rotation (theta) was shown for: talocrural extreme dorsiflexion to extreme plantarflexion (root mean square direction deviation (eta) 5.3 degrees and theta: SD 11.0 degrees), talorucral and subtalar extreme combined eversion-dorsiflexion to combined inversion-plantarflexion (eta: 6.7 degrees , theta: SD 9.0 degrees and eta:6.3 degrees , theta: SD 5.1 degrees), and subtalar extreme inversion to extreme eversion (eta: 6.4 degrees, theta: SD 5.9 degrees). Nearly all dorsi--and plantarflexion occurs in the talocrural joint (theta: mean 63.3 degrees (SD 11 degrees)). The inversion and internal rotation components for extreme eversion to inversion were approximately three times larger for the subtalar joint (theta: mean 22.9 degrees and 29.1 degrees) than for the talocrural joint (theta: mean 8.8 degrees and 10.7 degrees). Comparison of the ranges of motion of the pathologic ankle joint with the healthy subjects showed an increased inversion and axial rotation in the talocrural joint instead of in the suspected subtalar joint. INTERPRETATION: The proposed diagnostic technique and the acquired database of helical parameters of ankle joint ranges of motion are suitable to apply in clinical cases.

In-vivo range of motion of the subtalar joint using computed tomography.

Understanding in vivo subtalar joint kinematics is important for evaluation of subtalar joint instability, the design of a subtalar prosthesis and for analysing surgical procedures of the ankle and hindfoot. No accurate data are available on the normal range of subtalar joint motion. The purpose of this study was to introduce a method that enables the quantification of the extremes of the range of motion of the subtalar joint in a loaded state using multidetector computed tomography (CT) imaging. In 20 subjects, an external load was applied to a footplate and forced the otherwise unconstrained foot in eight extreme positions. These extreme positions were foot dorsiflexion, plantarflexion, eversion, inversion and four extreme positions in between the before mentioned positions. CT images were acquired in a neutral foot position and each extreme position separately. After bone segmentation and contour matching of the CT data sets, the helical axes were determined for the motion of the calcaneus relative to the talus between four pairs of opposite extreme foot positions. The helical axis was represented in a coordinate system based on the geometric principal axes of the subjects' talus. The greatest relative motion between the calcaneus and the talus was calculated for foot motion from extreme eversion to extreme inversion (mean rotation about the helical axis of 37.3+/-5.9 degrees, mean translation of 2.3+/-1.1 mm). A consistent pattern of range of subtalar joint motion was found for motion of the foot with a considerable eversion and inversion component.