title: The geometric architecture of the subtalar and midtarsal joints in rheumatoid arthritis based on magnetic resonance imaging.
abstract: OBJECTIVE
  To compare in vivo the 3-dimensional (3-D) geometric architecture of the subtalar and midtarsal joints in normal and rheumatoid arthritic (RA) feet, using magnetic resonance imaging (MRI) analysis.
  
  
  METHODS
  MRI was performed on 23 patients with RA, all of whom had disease activity in the subtalar and/or midtarsal joints. Image processing techniques were used to create 3-D reconstructions of the calcaneus (C), cuboid (c), navicular (N), and talus (T) bones. Twenty-four standard architectural parameters were measured from the reconstructions and were compared with data from 10 normal subjects. These parameters defined both 3-D distance and angular relationships among the 4 bones studied. Pattern classification techniques were used to establish a geometric architecture foot profile for the RA patients. The degree of individual patient fit to the new RA foot profile and to profiles for normal, pes planus, and pes cavus foot types was derived. Logistic regression was used to examine the relationship of foot architecture to inflammatory disease characteristics and physical examination variables.
  
  
  RESULTS
  Subtalar or midtarsal pain was reported by all 23 patients, and 22 of the 23 patients presented with >/=1 clinical feature of pes planovalgus deformity. In 21 patients, ultrasonography revealed synovitis at >/=1 tarsal joint or surrounding tendon. In the RA group, the normalized distances between the geometric centroids were significantly closer for bone pairs Cc and cT and significantly distracted for bone pair CN compared with the distances in normal subjects. In RA patients (versus normal subjects), the angles subtended at the bone centroids were significantly decreased in 3 bone groups (CNc, TCN, and TNc) and significantly increased in 3 bone groups (CcN, CcT, NTc). The angles formed between the major principal axes of bone pairs CT and cT were significantly increased in RA patients compared with those in normal subjects. Pattern classification defined 11 RA feet as having normal structure and 12 as having abnormal structure. However, the abnormal feet did not fit consistently with structures defined for RA, pes planus, or pes cavus foot types. Logistic regression demonstrated that subtalar joint synovitis was the only predictive factor for abnormal subtalar and midtarsal architecture (odds ratio 19.2, 95% confidence interval 1.77-200.0).
  
  
  CONCLUSIONS
  This unique 3-D MRI-based technique successfully quantified the effects of RA on the geometric architecture of the foot and the patient-specific nature of these changes. This technique can be used to provide logical therapy for correction.
authors.affiliation: Rheumatology & Rehabilitation Research Unit, University of Leeds, Leeds, UK. j.woodburn@leeds.ac.uk
authors.forename: James
authors.initials: J
authors.lastname: Woodburn
authors.forename: Jayaram K
authors.initials: JK
authors.lastname: Udupa
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Hirsch
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wakefield
authors.forename: Philip S
authors.initials: PS
authors.lastname: Helliwell
authors.forename: Naomi
authors.initials: N
authors.lastname: Reay
authors.forename: Philip
authors.initials: P
authors.lastname: O'Connor
authors.forename: Adam
authors.initials: A
authors.lastname: Budgen
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging / Q000473:pathology*; D005544:Forecasting; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D014463:Ultrasonography