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Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study.

Publication ,  Journal Article
de Cesar Netto, C; Godoy-Santos, AL; Saito, GH; Lintz, F; Siegler, S; O'Malley, MJ; Deland, JT; Ellis, SJ
Published in: J Bone Joint Surg Am
October 16, 2019

BACKGROUND: Progressive peritalar subluxation (PTS) is part of adult acquired flatfoot deformity (AAFD). We investigated the use of the middle facet as an indicator of PTS using standing, weight-bearing computed tomography (CT) images. We hypothesized that weight-bearing CT would be an accurate method of measuring increased subluxation ("uncoverage") and incongruence of the middle-facet among patients with AAFD. METHODS: We included 30 patients with stage-II AAFD (20 female and 10 male; mean age, 57.4 years [range, 24 to 78 years]) and 30 matched controls (20 female and 10 male; mean age, 51.8 years [range, 19 to 81 years]) who underwent standing, weight-bearing CT. Two independent and blinded fellowship-trained foot and ankle surgeons measured the amount of subluxation (percentage of uncoverage) and the incongruence angle of the middle facet at the midpoint of its longitudinal length, using coronal-plane, weight-bearing, cone-beam CT images. Intraobserver and interobserver reliabilities were assessed using intraclass correlation coefficients (ICCs). Comparisons were performed using independent t tests or Wilcoxon tests. P values of <0.05 were considered significant. RESULTS: Substantial to almost perfect intraobserver and interobserver reliability was observed for both measurements. We found that the middle facet demonstrated significantly increased PTS in patients with AAFD, with a mean value for joint uncoverage of 45.3% (95% confidence interval [CI], 38.5% to 52.1%) compared with 4.8% (95% CI, 3.2% to 6.4%) in controls (p < 0.0001). A significant difference was also found for the incongruence angle, with a mean value of 17.3° (95% CI, 14.7° to 19.9°) in the AAFD group and 0.3° (95% CI, 0.1° to 0.5°) in controls (p < 0.0001). A joint incongruence angle of >8.4° was found to be diagnostic for symptomatic stage-II AAFD. CONCLUSIONS: We investigated the use of the middle facet of the subtalar joint as a marker for PTS in patients with AAFD. We confirmed that standing, weight-bearing CT images allowed accurate measurements and that significant differences were found in the percentage of joint uncoverage and the incongruence angle compared with controls. CLINICAL RELEVANCE: The assessment of the amount of subluxation and incongruence of the middle facet of the subtalar joint represents an accurate diagnostic tool for symptomatic adult acquired flatfoot deformity.

Duke Scholars

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

October 16, 2019

Volume

101

Issue

20

Start / End Page

1838 / 1844

Location

United States

Related Subject Headings

  • Young Adult
  • Weight-Bearing
  • Tomography, X-Ray Computed
  • Subtalar Joint
  • Orthopedics
  • Observer Variation
  • Middle Aged
  • Male
  • Joint Dislocations
  • Humans
 

Citation

APA
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ICMJE
MLA
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de Cesar Netto, C., Godoy-Santos, A. L., Saito, G. H., Lintz, F., Siegler, S., O’Malley, M. J., … Ellis, S. J. (2019). Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study. J Bone Joint Surg Am, 101(20), 1838–1844. https://doi.org/10.2106/JBJS.19.00073
Cesar Netto, Cesar de, Alexandre Leme Godoy-Santos, Guilherme H. Saito, Francois Lintz, Sorin Siegler, Martin J. O’Malley, Jonathan T. Deland, and Scott J. Ellis. “Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study.J Bone Joint Surg Am 101, no. 20 (October 16, 2019): 1838–44. https://doi.org/10.2106/JBJS.19.00073.
de Cesar Netto C, Godoy-Santos AL, Saito GH, Lintz F, Siegler S, O’Malley MJ, et al. Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study. J Bone Joint Surg Am. 2019 Oct 16;101(20):1838–44.
de Cesar Netto, Cesar, et al. “Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study.J Bone Joint Surg Am, vol. 101, no. 20, Oct. 2019, pp. 1838–44. Pubmed, doi:10.2106/JBJS.19.00073.
de Cesar Netto C, Godoy-Santos AL, Saito GH, Lintz F, Siegler S, O’Malley MJ, Deland JT, Ellis SJ. Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study. J Bone Joint Surg Am. 2019 Oct 16;101(20):1838–1844.

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

October 16, 2019

Volume

101

Issue

20

Start / End Page

1838 / 1844

Location

United States

Related Subject Headings

  • Young Adult
  • Weight-Bearing
  • Tomography, X-Ray Computed
  • Subtalar Joint
  • Orthopedics
  • Observer Variation
  • Middle Aged
  • Male
  • Joint Dislocations
  • Humans