PURPOSE: The purpose of this study is to analyze the measurement differences of simple radiographs according to radiation projection angle using a phantom and to propose methods for objective analysis of simple radiographs. MATERIALS AND METHODS: We took simple radiographs with different projection angles using a C-arm image intensifier and measured five parameters of the foot on the simple radiographic images. Five parameters include lateral tibiocalcaneal angle, lateral talocalcaneal angle, naviculocuboid overlap, lateral talo-first metatarsal angle, and lateral calcaneo-first metatarsal angle. Intraobserver and interobserver reliability were verified, and then intraclass correlations of parameters were analyzed. RESULTS: Radiographic parameters of the foot showed high intraobserver and interobserver reliability. Lateral tibiocalcaneal angle has a strong negative linear relationship with rotation and a moderate negative linear relationship with tilt. Lateral talocalcaneal angle has a moderate positive linear relationship with rotation and a strong positive linear relationship with tilt. Naviculocuboid overlap has a strong positive linear relationship with rotation and a moderate positive linear relationship with tilt. Lateral talo-first metatarsal angle does not have a linear relationship with rotation and a moderate negative linear relationship with tilt. Lateral calcaneo-first metatarsal angle has a moderate positive linear relationship with rotation and tilt. CONCLUSION: More precise evaluation of the foot with a simple radiograph can be performed by understanding the changes of radiographic parameters according to radiation projection angle.
Foot* ; Metatarsal Bones ; Phantoms, Imaging ; Radiography

PURPOSE: The purpose of this study was to analyze the diagnostic availability and to examine the co-relation between pedobaragraphy and radiography of pediatric flexible flatfoot. MATERIALS AND METHODS: Seventeen patients and ten normal children were studied. In radiographic evaluation, the talo-1st metatarsal angle was measured on anteroposterior radiographs; and the talo-1st metatarsal angle, the talo-horizontal angle, the calcaneal pitch, and the talocalcaneal angle were measured on lateral radiographs. In pedobarography, foot pressures were subdivided into eight areas for measurement of contact time, ratio of measured area and to investigate the relation between the degree of the medial deviation of the Center of pressure line and the radiographic measurements. RESULTS: Flat foot group and normal group showed statistically significant difference in every angle measured in lateral radiographs. The foot pressure ratios of the lateral sides in forefoot and the medial and lateral sides of midfoot and the medial side of hindfoot between the flexible flatfoot group and normal group showed statistically significant difference in pedobarography and ratio of contact area in forefoot and hindfoot showed significant change in statistics but no changes in contact time. The relation between pedobarography and radiography was investigated: foot pressure of the medial and lateral side of forefoot and the talocalcaneal angle showed significant relation in statistics and foot pressure of the medial and lateral side of mid foot and every angle measured in lateral radiographs showed significant relation in statistics. Contact time of midfoot and every radiographic value measured in lateral radiograph showed significant relation in statistics and contact area of forefoot and midfoot showed significant relation with every radiographic value measured in lateral radiographs. In addition, medial deviation of center of pressure line showed significant relation in statistics with talus-first metatarsal angle measured on anteroposterior radiographs and talo-horizontal angle and talus-first metatarsal angle measured on lateral radiographs. CONCLUSION: The results of this study showed correlation between radiologic methods and pedobarography in diagnosis of pediatric flexible flatfoot and pedobarography is an useful tool in quantitative and qualitative analysis of the degree of foot deformity and medial deviation of center of pressure line.
Child ; Diagnosis ; Flatfoot* ; Foot ; Foot Deformities ; Humans ; Metatarsal Bones ; Radiography

OBJECTIVE: To investigate the correlation between the Foot Posture Index (FPI) (including talar head palpation, curvature at the lateral malleoli, inversion/eversion of the calcaneus, talonavicular bulging, congruence of the medical longitudinal arch, and abduction/adduction of the forefoot on the rare foot), plantar pressure distribution, and pediatric flatfoot radiographic findings. METHODS: Nineteen children with flatfoot (age, 9.32+/-2.67 years) were included as the study group. Eight segments of plantar pressure were measured with the GaitView platform pressure pad and the FPI was measured in children. The four angles were measured on foot radiographs. We analyzed the correlation between the FPI, plantar pressure characteristics, and the radiographic angles in children with flatfoot. RESULTS: The ratio of hallux segment pressure and the second through fifth toe segment pressure was correlated with the FPI (r=0.385, p=0.017). The FPI was correlated with the lateral talo-first metatarsal angle (r=0.422, p=0.008) and calcaneal pitch (r=-0.411, p=0.01). CONCLUSION: Our results show a correlation between the FPI and plantar pressure. The FPI and pediatric flatfoot radiography are useful tools to evaluate pediatric flatfoot.
Calcaneus ; Child ; Flatfoot* ; Foot* ; Hallux ; Head ; Humans ; Metatarsal Bones ; Palpation ; Pediatrics ; Posture* ; Radiography ; Toes

PURPOSE: We aimed to evaluate the magnetic resonance imaging (MRI) findings of congenital postaxial polydactyly of the foot. MATERIALS AND METHODS: Three-hundred and forty-seven feet of 288 patients who underwent congenital postaxial polydactyly or polysyndactyly correction were divided into five subtypes according to the radiographic shapes of deformity origins (widened metatarsal head, bifid, fused duplicated, incompletely duplicated, or completely duplicated). MRIs were assessed to determine whether they unrevealed areas were fused or separated. MRI was also used to assess cases with radiographic phalangeal aplasia. RESULTS: Huge variations were noted in MRIs. Fusion or separation at the base or head between original and extra digits were observed, and MRI effectively depicted phalangeal aplastic areas. CONCLUSION: MRI evaluations of congenital postaxial polydactyly of the foot are useful for determining the anatomical statuses which were not visualized by plain radiography (level of evidence: 3).
Congenital Abnormalities ; Foot* ; Head ; Humans ; Magnetic Resonance Imaging ; Metatarsal Bones ; Polydactyly* ; Radiography ; Syndactyly

OBJECTIVE: The purpose of this study was to evaluate the difference for each variable on plain radiologic study of the foot between weighted and non-weighted routine plain anterior-posterior and lateral views in flatfoot children diagnosed by Harris mat footprint. METHOD: Both feet of thirty-four children over two-year old, who had been diagnosed as flatfooted by modified Rose' classification using Harris mat footprint were included. We studied plain roentgenogram images, including anterior-posterior and lateral views, in both standing (weighted) and sitting (non weighted) position of the feet of the patients. We measured the following variables; arch height (AH), calcaneal pitch (CP), talocalcaneal angles from lateral view (TCALA) and anterior-posterior view (TCAAP), talo-first metatarsal angles from the lateral (TFML) and anterior-posterior view (TFMA). RESULTS: Each variable revealed no significant difference between boys and girls (p>0.05); neither was there any significant difference noted in each parameter between the right and left feet (p>0.05). All the variables of plain foot roentgenogram on weighted state were significantly different from the data of non-weighted state, except TCAAP (p<0.05). CP was the only parameter which showed significant difference according to severity of flatfoot by modified Rose'classification. CONCLUSION: Because most of the flatfoot in childhood is hypermobile type, it is necessary to take plain radiologic studies of the feet both in weighted and non weighted state and to compare both data of each variable. In addition, it is prefer to use plain radiologic study of foot both in weighted and non weighted state with footprint as the screening method of pediatric flatfoot lesions.
Child ; Classification ; Female ; Flatfoot* ; Foot ; Humans ; Mass Screening ; Metatarsal Bones ; Radiography

OBJECTIVE: To evaluate whether 7 radiographic angles make a useful method for analysing foot deformities in children with cerebral palsy, and to assess with changes in angles after 2 years with orthoses or operations. METHOD: The talocalcaneal, talus-first metatarsal, and calcaneus-fifth metatarsal angles on the AP radiographs and the talocalcaneal, tibiotalar, talus-first metatarsal, and talohorizontal angles on the lateral radiographs were measured in 183 cerebral palsied. Seven angles were analyzed according to the clinical types, spasticity, ambulation, and age. One hundred three feet were followed up for 2 years with application of orthoses or operations. RESULTS: The frequencies of higher range in AP talocalcaneal angle were 24.4% in spastic diplegia. The increased frequencies for abnormal range increased as the grade of spasticity. Non-ambulator group had many frequencies of lower range in AP talocalcaneal angle. The age of 8~9 years showed high peak in the frequency of abnormal range. After 2 years, the frequencies of normal range were increased in groups with orthoses or operations. CONCLUSION: The radiographic angles were a useful method for observing feet of the children with cerebral palsy. If the appropriate interventions for feet were applied, the normal frequencies of radiographic angles were increased after 2 years.
Cerebral Palsy* ; Child* ; Foot Deformities* ; Foot* ; Humans ; Metatarsal Bones ; Muscle Spasticity ; Orthotic Devices ; Radiography ; Reference Values ; Walking

PURPOSE: Pes planovalgus is one of the most common foot deformities among pediatric orthopedic diseases and is divided into idiopathic and neuromuscular planovalgus according to its etiology. This study evaluated the radiologic and pedobarographic outcomes of the treatment for pes planovalgus in children treated with lateral column lengthening, compared the outcomes according to the etiology, and investigated the correlation between the radiologic and pedobarographic findings. MATERIALS AND METHODS: Sixty-three patients (97 feet), who underwent lateral column lengthening, were divided into groups of 30 patients (47 feet) with neuromuscular disease and 33 patients (50 feet) with idiopathic etiology. The preoperative, immediately postoperative, 1 year, and 3 year follow-up radiographic measurements on the plain radiograph antero-posterior (AP) and lateral view were compared. In pedobarography, the foot pressures were subdivided into 4 areas to measure the contact time, contact area, peak pressure, and maximum force. The pre- and postoperative pedobarographic measurements were compared and the correlations between the radiographic and pedobarographic measurements were evaluated. RESULTS: The radiographic index at the 1st postoperative year and 3rd postoperative follow-up did not show significant differences according to the etiology. In pedobarography, idiopathic planovalgus showed a significant increase in the maximum force in the hindfoot and forefoot. The correlation between the radiologic findings and pedobarographic findings was statistically significant between the tibiocalcaneal angle in the lateral view and the maximum force, and the contact area of hindfoot on pedobarography, between tibiocalcaneal angle in the lateral view and the contact area of the toes in idiopathic planovalgus. In neuromuscular planovalgus, the peak pressure in the hindfoot had a strong negative correlation with talonavicular coverage angle in the AP view and talo-1st metatarsal angle, and the talohorizontal angle in the lateral view. CONCLUSION: Lateral column lengthening is an effective surgical procedure for flatfoot patients. On the other hand, the radiographic examination has limitations for accurate assessments of the postoperative results and prognosis. Qualitative and quantitative evaluations are available by pedobarography and it is a useful instrument for an evaluation of planovalgus when used in conjunction with radiography.
Child ; Evaluation Studies as Topic ; Flatfoot ; Follow-Up Studies ; Foot ; Foot Deformities ; Hand ; Humans ; Metatarsal Bones ; Neuromuscular Diseases ; Orthopedics ; Prognosis ; Radiography ; Toes

PURPOSE: To evaluate the effect of shortening scarf osteotomy on pain relief and range of motion (ROM) of the first metatarsophalangeal joint in hallux rigidus patients. MATERIALS AND METHODS: Twenty-three cases of 19 patients who had been treated with shortening scarf osteotomy for the hallux rigidus between January 2007 and December 2013 were reviewed. The mean follow-up period was 21.4 months, and the mean age was 59.2 years. The first metatarsal bone was shortened until the ROM of the first metatarsophalangeal joint was greater than 80° or 40° of dorsiflexion. The length shortened by scarf osteotomy was measured. The authors also measured and compared the joint interval difference of the standing foot using an anteroposterior radiography. Moreover, the difference of ROM of the first metatarsophalangeal joint between the preoperative and final follow-up periods was also compared. The clinical results were evaluated and compared using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and visual analogue scale (VAS) score. RESULTS: The mean shortening length was about 6.5 mm (range, 4∼9 mm). The joint space has been increased to 1.8 mm, and the ROM of the first metatarsophalangeal joint has also been increased to 18.4° after the operation. In three cases, the postoperative ROM has been decreased to less 10°. The AOFAS score has been improved from 41.7 (range, 32∼55) to 86.2 (range, 65∼95), and the VAS score was also decreased from 3.7 (range, 3∼5) to 1.3 (range, 0∼3). Two cases have shown no decrease in pain even after the operation. CONCLUSION: Shortening scarf osteotomy was found to decrease joint pain by decompressing the pressure of the first metatarsophalangeal joint. This osteotomy also helped improve the ROM of the first metatarsophalangeal joint. Shortening scarf osteotomy can be considered one of the effective methods for joint preservation.
Ankle ; Arthralgia ; Congenital Abnormalities* ; Follow-Up Studies ; Foot ; Hallux Rigidus* ; Hallux* ; Humans ; Joints ; Metatarsal Bones ; Metatarsophalangeal Joint ; Osteotomy* ; Radiography ; Range of Motion, Articular

Hallux valgus is a lateral deviation of the first phalanx and medial deviation of the first metatarsal at the first metatarsophalangeal (MP) joint. Its incidence has increased due to developing footwear. The etiologies include fashion footwear, genetic causes, anatomical abnormality around the foot, rheumatoid arthritis, and neuromuscular disorders. Physiologic alignment of the first MP joint is maintained by congruent and symmetric alignment of the articular surface of the first proximal phalanx and first metatarsal head, physiologic relationship of the distal first metatarsal articular surface and the first metatarsal shaft axis, and stable balance of soft tissue around the first MP joint and stable tarsometatarsal joint. Several factors have been associated with hallux valgus, including pes planus, hypermobility of the first tarsometatarsal joint, flattened shape of the first metatarsal head, increased distal metatarsal articular angle, and deformation of the medial capsular integrity. History and physical examination are very important to diagnosis of hallux valgus. Simple radiography provides information on deformity, particularly in weight-bearing anteroposterior and lateral radiographs. Understanding the etiologies and pathophysiology is very important for success in treatment of patients with hallux valgus.
Arthritis, Rheumatoid ; Axis, Cervical Vertebra ; Congenital Abnormalities ; Diagnosis* ; Flatfoot ; Foot ; Hallux Valgus* ; Head ; Humans ; Incidence ; Joints ; Metatarsal Bones ; Physical Examination ; Radiography ; Weight-Bearing

INTRODUCTIONAnatomical markers can help to guide lag screw placement during surgery for internal fixation of fifth metatarsal base fractures. This study aimed to identify the optimal anatomical markers and thus reduce radiation exposure.

METHODSA total of 50 patients in Huashan Hospital, Shanghai, China, who underwent oblique foot radiography in the lateral position were randomly selected. The angles between the fifth metatarsal axis and cuboid articular surface were measured to determine the optimal lag screw placement relative to anatomical markers.

RESULTSThe line connecting the styloid process of the fifth metatarsal base with the second metatarsophalangeal (MTP) joint intersected with the fifth metatarsal base fracture line at an angle of 86.85° ± 5.44°. The line connecting the fifth metatarsal base styloid with the third and fourth MTP joints intersected with the fracture line at angles of 93.28° ± 5.24° and 100.95° ± 5.00°, respectively. The proximal articular surface of the fifth metatarsal base intersected with the line connecting the styloid process of the fifth metatarsal base with the second, third and fourth MTP joints at angles of 24.02° ± 4.77°, 30.79° ± 4.53° and 38.08° ± 4.54°, respectively.

CONCLUSIONThe fifth metatarsal base styloid and third MTP joint can be used as anatomical markers for lag screw placement in fractures involving the fifth tarsometatarsal joint. The connection line, which is normally perpendicular to the fracture line, provides sufficient mechanical stability to facilitate accurate screw placement. The use of these anatomical markers could help to reduce unnecessary radiation exposure for patients and medical staff.

Bone Screws ; China ; Foot ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Metatarsal Bones ; radiation effects ; surgery ; Patient Positioning ; Radiation Exposure ; Radiography ; Stress, Mechanical