Assessment of lateral hindfoot pain in acquired flatfoot deformity using weightbearing multiplanar imaging.
BACKGROUND
The etiology of lateral hindfoot pain in flatfoot deformity can be difficult to assess on plain radiographs. We hypothesized that multiplanar measurements obtained in a fully upright, weightbearing position would reliably demonstrate an increase in lateral hindfoot arthrosis and/or impingement in a cohort of flatfoot patients with lateral hindfoot pain compared to a cohort without pain.


METHODS
Ten consecutive patients with flexible flatfoot deformity and lateral hindfoot pain (mean age, 55.5 +/- 13.9) were compared to 10 consecutive patients with flexible deformity but no pain (mean age, 61.0 +/- 8.6). Conventional radiographs and weightbearing multiplanar images were performed on all patients before surgical reconstruction. Flatfoot, hindfoot impingement, and arthrosis parameters were interpreted in a blinded fashion by two musculoskeletal radiologists. Interrater reliability was determined with intraclass correlation coefficients (ICC). All parameters were compared between groups with a Wilcoxon rank sum test (p < 0.05).


RESULTS
A significant increase in posterior facet subtalar arthrosis (p = 0.006) and combined anterior and posterior facet subtalar arthrosis (p = 0.022) was evident in the pain group. Calcaneofibular impingement and calcaneocuboid arthritis were increased in the pain group, but did not reach significance (p = 0.057 and p = 0.067 respectively). The multiplanar imaging parameters demonstrated good (ICC = 0.60 to 0.73) to excellent (ICC >or= 0.74) reliability for most impingement and arthrosis parameters and for many of the standard flatfoot parameters.


CONCLUSIONS
The results indicate that weightbearing, multiplanar imaging provides a reliable means of assessing lateral pain in patients with flexible flatfoot deformity.
Ellis
Scott J
SJ
Department of Foot and Ankle Surgery, The Hospital for Special Surgery, New York, NY 10021, USA. elliss@hss.edu
Deyer
Timothy
T
Williams
Benjamin R
BR
Yu
Joseph C
JC
Lehto
Scott
S
Maderazo
Alex
A
Pavlov
Helene
H
Deland
Jonathan T
JT
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005413:Flatfoot / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005531:Foot Deformities, Acquired / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D033023:Foot Joints / Q000000981:diagnostic imaging / Q000503:physiopathology; D006365:Heel; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010146:Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D016474:Weight-Bearing; D055815:Young Adult