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Radiographic-directed local coordinate systems critical in kinematic analysis of walking in diabetes-related medial column foot deformity.

ABSTRACT: Diabetic foot deformity onset and progression maybe associated with abnormal foot and ankle motion. The modified Oxford multi-segmental foot model allows kinematic assessment of inter-segmental foot motion. However, there are insufficient anatomical landmarks to accurately representation the alignment of the hindfoot and forefoot segments during model construction. This is most notable for the sagittal plane which is referenced parallel to the floor, allowing comparison of inter-segmental excursion but not capturing important sagittal hind-to-forefoot deformity associated with diabetic foot disease and can potentially underestimate true kinematic differences. The purpose of the study was to compare walking kinematics using local coordinate systems derived from the modified Oxford model and the radiographic directed model which incorporated individual calcaneal and 1st metatarsal declination pitch angles for the hindfoot and forefoot. We studied twelve participants in each of the following groups: (1) diabetes mellitus, peripheral neuropathy and medial column foot deformity (DMPN+), (2) DMPN without medial column deformity (DMPN-) and (3) age- and weight-match controls. The modified Oxford model coordinate system did not identify differences between groups in the initial, peak, final, or excursion hindfoot relative to shank or forefoot relative to hindfoot dorsiflexion/plantarflexion during walking. The radiographic coordinate system identified the DMPN+ group to have an initial, peak and final position of the forefoot relative to hindfoot that was more dorsiflexed (lower arch phenotype) than the DMPN- group (p<.05). Use of radiographic alignment in kinematic modeling of those with foot deformity reveals segmental motion occurring upon alignment indicative of a lower arch.

SUBMITTER: Hastings MK

PROVIDER: S-EPMC4038905 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Radiographic-directed local coordinate systems critical in kinematic analysis of walking in diabetes-related medial column foot deformity.

Hastings Mary K MK Woodburn James J Mueller Michael J MJ Strube Michael J MJ Johnson Jeffrey E JE Beckert Krista S KS Stein Michelle L ML Sinacore David R DR

Gait & posture 20140315 1

Diabetic foot deformity onset and progression maybe associated with abnormal foot and ankle motion. The modified Oxford multi-segmental foot model allows kinematic assessment of inter-segmental foot motion. However, there are insufficient anatomical landmarks to accurately representation the alignment of the hindfoot and forefoot segments during model construction. This is most notable for the sagittal plane which is referenced parallel to the floor, allowing comparison of inter-segmental excurs ...[more]

PMID: 24703359

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Project description:BackgroundProgressive collapsing foot deformity (PCFD) is a progressive hindfoot and midfoot deformity causing pain and disability. Although operative treatment is stage dependent, few studies have looked at patient-reported and radiographic outcomes stratified by primary vs revision stage II, III, and IV reconstruction surgery. Our goal was to assess operative improvement using Patient-Reported Outcomes Measurement Information System (PROMIS) and to determine whether radiographic parameter improvement correlates with patient-reported outcomes.MethodsPROMIS Physical Function (PF) and Pain Interference (PI) scores were prospectively obtained on 46 consecutive patients who underwent PCFD reconstruction between November 2013 and January 2019. Thirty-six patients completed pre- and postoperative PROMIS surveys, 6 patients completed only preoperative PROMIS surveys, and 4 patients completed 12-month postoperative PROMIS surveys but did not complete preoperative PROMIS surveys. Minimum follow-up was 12 (average, 23) months. Radiographic correction was measured with pre- and postoperative weightbearing radiographs and correlated with PROMIS scores. Measurements included the talonavicular uncoverage angle, talonavicular uncoverage percentage, anteroposterior talo-first metatarsal angle, Meary angle, medial cuneiform height (MCH), and medial cuneiform-fifth metatarsal height.ResultsFor the overall cohort, PROMIS PF increased significantly from 37.5±5.6 to 42.3±7.1 (P = .0014). PROMIS PI improved significantly from 64.5±6.0 to 55.1±9.8 (P < .0001). Preoperative, postoperative, and change in PROMIS scores were not statistically different between PCFD stages. Change in PROMIS PI was significantly greater in primary (-12.3) vs revision (-3.7) surgery (P = .0157). Change in PROMIS PF was greater in primary (+6.0) vs revision surgery (+2.3) but did not reach statistical significance. All radiographic measurements improved significantly (P < .05). In primary stage II PCFD, postoperative PROMIS scores correlated with postoperative MCH (PF: r = 0.7725, P = .0020; PI: r = -0.5692, P = .0446).ConclusionPatient-reported and radiographic outcomes improved significantly after PCFD reconstruction. We found no significant difference in preoperative, postoperative, or change in PROMIS scores between PCFD stages. However, stage III patients had smaller improvements in PROMIS PF, which we feel may be secondary to change in function after arthrodesis. Primary operations had better patient-reported outcomes compared to revision operations. In primary stage II PCFD, reconstructing the medial arch height correlated significantly with improvement in pain and functionality.Level of evidenceLevel II, prospective cohort study.

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Dataset Information

Radiographic-directed local coordinate systems critical in kinematic analysis of walking in diabetes-related medial column foot deformity.

Publications

Radiographic-directed local coordinate systems critical in kinematic analysis of walking in diabetes-related medial column foot deformity.

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