Assessment of lateral hindfoot pain in acquired flatfoot deformity using weightbearing multiplanar imaging

Scott J. Ellis, Timothy Deyer, Benjamin R. Williams, Joseph C. Yu, Scott Lehto, Alex Maderazo, Helene Pavlov, Jonathan T. Deland

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

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. Materials and 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 ≥ 0.74) reliability for most impingement and arthrosis parameters and for many of the standard flatfoot parameters. Conclusion: The results indicate that weightbearing, multiplanar imaging provides a reliable means of assessing lateral pain in patients with flexible flatfoot deformity.

Original languageEnglish
Pages (from-to)361-371
Number of pages11
JournalFoot and Ankle International
Volume31
Issue number5
DOIs
StatePublished - May 2010
Externally publishedYes

Keywords

  • Flatfoot
  • Lateral pain
  • Multiplanar imaging
  • Standing
  • Upright
  • Weightbearing

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