Prediction of spatial orientation and morphology of calcaneonavicular coalitions.
BACKGROUND
Calcaneonavicular coalitions (CNC) have been reported to be associated with anatomical aberrations of either the calcaneus and/or navicular bones. These morphological abnormalities may complicate accurate surgical resection. Three-dimensional analysis of spatial orientation and morphological characteristics may help in preoperative planning of resection.


METHODS
Sixteen feet with a diagnosis of CNC were evaluated by means of 3-D CT modeling. Three angles were defined that were expressed in relation to one reproducible landmark (lateral border of the calcaneus): the dorsoplantar inclination, anteroposterior inclination, and socket angle. The depth and width of the coalitions were measured and calculated to obtain the estimated contact surface. Three-dimensional reconstructions of the calcanei served to evaluate the presence, distortion or absence of the anterior calcaneal facet and presence of a navicular beak. The interrater correlations were assessed in order to obtain values for the accuracy of the measurement methods. Sixteen normal feet were used as controls for comparison of the socket angle; anatomy of the anterior calcaneal facet and navicular beak as well.


RESULTS
The dorsoplantar inclination angle averaged 50 degrees (+/-17), the anteroposterior inclination angle 64 degrees (+/-15), and the pathologic socket angle 98 degrees (+/-11). The average contact area was 156 mm(2). Ninety-four percent of all patients in the CNC group revealed a plantar navicular beak. In 50% of those patients the anterior calcaneal facet was replaced by the navicular portion and in 44% the facet was totally missing. In contrast, the socket angle in the control group averaged 77 degrees (+/-18), which was found to be statistically different than the CNC group (p = 0.0004). Only 25% of the patients in the control group had a plantar navicular beak. High, statistically significant interrater correlations were found for all measured angles.


CONCLUSIONS
Computer-aided CT analysis and reconstructions help to determine the spatial orientations of CNC in space and provide useful information in order to anticipate morphological abnormalities of the calcaneus and navicular.
Espinosa
Norman
N
Department of Orthopaedics, Children's Hospital, Boston, MA 02115, USA. noresp@gmx.net
Dudda
Marcel
M
Andersen
Jason
J
Bernardi
Mark
M
Kasser
James R
JR
D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D005260:Female; D005530:Foot Deformities / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013639:Tarsal Bones / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D013640:Tarsal Joints / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed