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Hindfoot Alignment in Flexible Cavovarus Deformity Under Orthostatic and Coleman Block Test Positions: A Weightbearing Computed Tomography Study.

Publication ,  Journal Article
Pires, EA; Lobo, CFT; Fonseca, FC; Sposeto, RB; Barbachan Mansur, NS; Easley, ME; de Cesar Netto, C; Godoy-Santos, AL
Published in: Foot Ankle Int
September 2024

BACKGROUND: Flexible cavovarus deformity is prevalent and the Coleman block test is frequently used to assess the first ray plantarflexion malpositioning in the overall deformity as well as the flexibility of the hindfoot. The objective was to assess and compare the weightbearing computed tomography (WBCT) 3-dimensional (3D) changes in clinical and bone alignment in flexible cavovarus deformity patients when performing the Coleman block test when compared to normal standing position and to controls. METHODS: Twenty patients (40 feet) with flexible cavovarus deformity and 20 volunteer controls (40 feet) with normal foot alignment underwent WBCT imaging of the foot and ankle. Cavovarus patients were assessed in normal orthostatic and Coleman block test positions. Foot and ankle offset (FAO), hindfoot alignment angle (HAA), talocalcaneal angle (TCA), subtalar vertical angle (SVA) and talonavicular coverage angle (TNCA) and a CT-simulated soft tissue envelope image, WBCT clinical hindfoot alignment angle (WBCT-CHAA), were evaluated by 2 readers. Measurements were compared between cavovarus nonstressed and stressed positions and to controls. P values of .05 or less were considered significant. RESULTS: The intra- and interobserver intraclass correlation coefficient were good or excellent for all WBCT measurements. Cavovarus patients demonstrated significant correction of WBCT-CHAA (9.7 ± 0.4 degrees), FAO (2.6 ± 0.4%), and TNCA (8.8 ± 1.8 degrees) when performing the Coleman block test (all P values <.0001). However, WBCT-CHAA and FAO measurements were still residually deformed and significantly different from controls (P values of .001 and <.0001, respectively). TNCA values corrected to values similar to healthy controls (P = .29). No differences were observed in cavovarus patients during Coleman block test for the coronal measures: HAA, TCA, and SVA measurements. CONCLUSION: In this study, we observed improvement in the overall 3D WBCT alignment (FAO), axial plane adduction deformity (TNCA), as well as CT simulated clinical hindfoot alignment (WBCT-CHAA) in flexible cavovarus deformity patients when performing a Coleman block test. However, we did not find improvement in measures of coronal alignment of the hindfoot, indicating continued varus positioning of the hindfoot in these patients.

Duke Scholars

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

September 2024

Volume

45

Issue

9

Start / End Page

1027 / 1037

Location

United States

Related Subject Headings

  • Young Adult
  • Weight-Bearing
  • Tomography, X-Ray Computed
  • Talipes Cavus
  • Orthopedics
  • Middle Aged
  • Male
  • Imaging, Three-Dimensional
  • Humans
  • Foot
 

Citation

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Pires, E. A., Lobo, C. F. T., Fonseca, F. C., Sposeto, R. B., Barbachan Mansur, N. S., Easley, M. E., … Godoy-Santos, A. L. (2024). Hindfoot Alignment in Flexible Cavovarus Deformity Under Orthostatic and Coleman Block Test Positions: A Weightbearing Computed Tomography Study. Foot Ankle Int, 45(9), 1027–1037. https://doi.org/10.1177/10711007241258180
Pires, Eduardo Araujo, Carlos Felipe Teixeira Lobo, Fabio Correa Fonseca, Rafael Barban Sposeto, Nacime Salomão Barbachan Mansur, Mark E. Easley, Cesar de Cesar Netto, and Alexandre Leme Godoy-Santos. “Hindfoot Alignment in Flexible Cavovarus Deformity Under Orthostatic and Coleman Block Test Positions: A Weightbearing Computed Tomography Study.Foot Ankle Int 45, no. 9 (September 2024): 1027–37. https://doi.org/10.1177/10711007241258180.
Pires EA, Lobo CFT, Fonseca FC, Sposeto RB, Barbachan Mansur NS, Easley ME, et al. Hindfoot Alignment in Flexible Cavovarus Deformity Under Orthostatic and Coleman Block Test Positions: A Weightbearing Computed Tomography Study. Foot Ankle Int. 2024 Sep;45(9):1027–37.
Pires, Eduardo Araujo, et al. “Hindfoot Alignment in Flexible Cavovarus Deformity Under Orthostatic and Coleman Block Test Positions: A Weightbearing Computed Tomography Study.Foot Ankle Int, vol. 45, no. 9, Sept. 2024, pp. 1027–37. Pubmed, doi:10.1177/10711007241258180.
Pires EA, Lobo CFT, Fonseca FC, Sposeto RB, Barbachan Mansur NS, Easley ME, de Cesar Netto C, Godoy-Santos AL. Hindfoot Alignment in Flexible Cavovarus Deformity Under Orthostatic and Coleman Block Test Positions: A Weightbearing Computed Tomography Study. Foot Ankle Int. 2024 Sep;45(9):1027–1037.
Journal cover image

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

September 2024

Volume

45

Issue

9

Start / End Page

1027 / 1037

Location

United States

Related Subject Headings

  • Young Adult
  • Weight-Bearing
  • Tomography, X-Ray Computed
  • Talipes Cavus
  • Orthopedics
  • Middle Aged
  • Male
  • Imaging, Three-Dimensional
  • Humans
  • Foot