Does the Sagittal Radiographic Morphology of Subtalar Joint Affect the Alignment of Foot?

Abstract

Objectives: The etiology of flatfoot and cavus foot is multicausal and controversial. So far, no literature reports the relationship between the sagittal morphology of subtalar joint and the alignment of foot. The purpose of this study was to explore whether the subtalar alignment would influence the configuration of foot.

Methods: From January 2017 to January 2020, we included 109 feet in the flatfoot group, 95 feet in the cavus group, and 104 feet in the control group in this retrospective comparative study. The Gissane angle and calcaneal posterior articular surface inclination angle represented the sagittal morphology of the subtalar joint. Meary's angle, calcaneal pitch angle, and talar pitch angle reflected the alignment of foot. They were measured in the weightbearing foot X-rays. The angles in different groups were compared via Mann–Whitney U test. We calculated the correlation between the sagittal alignment of subtalar joint and the alignment of foot using Spearman's correlation analysis. Interobserver and intraobserver reliability were calculated.

Results: The Gissane angle, calcaneal posterior articular surface inclination angle, Meary's angle, talar pitch angle, and calcaneal pitch angle were significantly different in the three groups. The Gissane angle had an excellent correlation with the Meary's angle (r = 0.850, p < 0.0001), and the talar pitch angle (r = -0.825, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = 0.638, p < 0.0001). The calcaneal posterior articular surface inclination angle had an excellent correlation with the Meary's angle (r = -0.902, p < 0.001), and the talar pitch angle (r = 0.887, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = -0.702, p < 0.0001). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent.

Conclusion: A subtalar joint with a larger Gissane angle and a more horizontal calcaneal posterior articular surface angle tended to have a higher foot arch and vice versa. The inspiration from this study was that the deformities of flatfoot and cavus foot may relate to the subtalar deformity.

Keywords

Alignment / Cavus foot / Flatfoot / Gissane angle / Subtalar joint

References

[1] BouchardM, MoscaVS. Flatfoot deformity in children and adolescents: surgical indications and management. J Am Acad Orthop Surg. 2014;22(10):623–632.

[2] MoscaVS. Flexible flatfoot in children and adolescents. J Child Orthop. 2010;4(2):107–121.

[3] BlumanEM, Myerson MS. Stage IV posterior tibial tendon rupture. Foot Ankle Clin. 2007;12(2):341–362. viii.

[4] TrnkaHJ. Dysfunction of the tendon of tibialis posterior. J Bone Joint Surg Br. 2004;86(7):939–946.

[5] XuY, LiXC, XuXY. Calcaneal Z lengthening osteotomy combined with subtalar Arthroereisis for severe adolescent flexible flatfoot reconstruction. Foot Ankle Int. 2016;37(11):1225–1231.

[6] ChenF, YuanC, LiangM, Le G, XuJ. Comparison of different surgical treatments for stage II progressive collapsing foot deformity: a finite element analysis. J Orthop Surg Res. 2023;18(1):719.

[7] Casado-HernandezI, Becerro-de-Bengoa-Vallejo R, Losa-IglesiasM, Gomez-SalgadoJ, Lopez-Lopez D, BayodJ. Variability of the lower limb symmetry index associated with the gait parameters in the overweight adult population with flatfoot: a case-control study. Front Bioeng Biotechnol. 2023;11:1189309.

[8] RosenbaumAJ, Lisella J, PatelN, PhillipsN. The cavus foot. Med Clin North Am. 2014;98(2):301–312.

[9] NogueiraMP, Farcetta F, ZucconA. Cavus Foot. Foot Ankle Clin. 2015;20(4):645–656.

[10] QinB, WuS, ZhangH. Evaluation and Management of Cavus Foot in adults: a narrative review. J Clin Med. 2022;11(13):3679.

[11] Arthur VithranDT, Liu X, HeM, EssienAE, OpokuM, LiY, et al. Current advancements in diagnosing and managing cavovarus foot in paediatric patients. EFORT Open Rev. 2024;9(1):69–79.

[12] WangB, Saltzman CL, ChalayonO, BargA. Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis? Clin Orthop Relat Res. 2015;473(1):318–325.

[13] CodyEA, Williamson ER, BurketJC, DelandJT, EllisSJ. Correlation of Talar anatomy and subtalar joint alignment on Weightbearing computed tomography with radiographic flatfoot parameters. Foot Ankle Int. 2016;37(8):874–881.

[14] KrahenbuhlN, Siegler L, DeforthM, ZwickyL, Hintermann B, KnuppM. Subtalar joint alignment in ankle osteoarthritis. Foot Ankle Surg. 2019;25(2):143–149.

[15] YoshimotoK, Noguchi M, YamadaA, NasuY. Compensatory function of the subtalar joint for lower extremity malalignment. Adv Orthop. 2019;2019:7656878.

[16] KrahenbuhlN, Tschuck M, BolligerL, HintermannB, KnuppM. Orientation of the subtalar joint: measurement and reliability using weightbearing CT scans. Foot Ankle Int. 2016;37(1):109–114.

[17] SchmutzB, LuthiM, Schmutz-LeongYK, ShulmanR, PlattS. Morphological analysis of Gissane's angle utilising a statistical shape model of the calcaneus. Arch Orthop Trauma Surg. 2021;141(6):937–945.

[18] KnightJR, GrossEA, BradleyGH, Bay C, LoVecchioF. Boehler's angle and the critical angle of Gissane are of limited use in diagnosing calcaneus fractures in the ED. Am J Emerg Med. 2006;24(4):423–427.

[19] LandisJR, KochGG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174.

[20] MeestersAML, Ten Duis K, BanierinkH, StirlerVMA, Wouters PCR, KraeimaJ, et al. FFA IJ: what are the Interobserver and Intraobserver variability of gap and Stepoff measurements in acetabular fractures? Clin Orthop Relat Res. 2020;478(12):2801–2808.

[21] SangeorzanA, Sangeorzan B. Subtalar joint biomechanics: from Normal to pathologic. Foot Ankle Clin. 2018;23(3):341–352.

[22] ZhangY, XuJ, WangX, Huang J, ZhangC, ChenL, et al. An in vivo study of hindfoot 3D kinetics in stage II posterior tibial tendon dysfunction (PTTD) flatfoot based on weight-bearing CT scan. Bone Joint Res. 2013;2(12):255–263.

[23] KidoM, IkomaK, ImaiK, Maki M, TakatoriR, TokunagaD, et al. Load response of the tarsal bones in patients with flatfoot deformity: in vivo 3D study. Foot Ankle Int. 2011;32(11):1017–1022.

[24] ZhangYJ, XuJ, WangY, Lin XJ, MaX. Correlation between hindfoot joint three-dimensional kinematics and the changes of the medial arch angle in stage II posterior tibial tendon dysfunction flatfoot. Clin Biomech (Bristol, Avon). 2015;30(2):153–158.

[25] NozakiS, Watanabe K, KamiyaT, KatayoseM, Ogihara N. Sex- and age-related morphological variations in the talar articular surfaces of the calcaneus. Ann Anat. 2020;229:151468.

[26] MaceiraE, Monteagudo M. Subtalar anatomy and mechanics. Foot Ankle Clin. 2015;20(2):195–221.

[27] KimKC, FayedA, SchmidtE, Carvalho KAM, LaleveeM, MansurN, et al. Relationship between obesity and medial longitudinal arch bowing. Foot Ankle Int. 2023;44(11):1181–1191.

RIGHTS & PERMISSIONS

2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.