The Effect of Lower Extremity Internal and External Rotation on the Hindfoot Alignment Moment Arm and Hindfoot Alignment Angle Article Swipe
Kamil Okroj
,
Ryan G. Rogero
,
Daniel Corr
,
Daniel Fuchs
,
Brian S. Winters
,
Joseph T. O’Neil
,
Rachel Shakked
,
Steven M. Raikin
·
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1177/2473011420s00373
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1177/2473011420s00373
Category: Ankle; Hindfoot Introduction/Purpose: The hindfoot moment arm was first described by Saltzman and el-Khoury to evaluate hindfoot varus and valgus alignment and has been well described and validated in the literature. It is commonly used by surgeons for preoperative planning of various hindfoot reconstructive procedures. The hindfoot alignment angle (the angle formed by the intersection between the tibial axis and the calcaneal axis) is another metric of measuring hindfoot alignment commonly utilized by surgeons. The purpose of this study was to determine if rotation of the hindfoot alters the hindfoot alignment moment arm and hindfoot alignment angle. We hypothesize that slight changes in internal and external rotation of the foot during x-ray positioning will have a large effect on the hindfoot moment arm and hindfoot alignment angle. Methods: We prospectively enrolled 29 patients, totaling 58 lower extremities, presenting to outpatient clinic for evaluation of a foot and ankle complaint. Patients <18 years of age, unable to perform bilateral weightbearing radiographs, or presenting for postoperative visits from recent foot and ankle surgery were excluded. Bilateral Saltzman hindfoot radiographs in neutral, 10 degrees of internal rotation, and 10 degrees of external rotation were performed. Marking lines were drawn on the standing platform to standardize rotation, with patients aligning their second ray with the lines. A fellowship-trained foot and ankle orthopaedic surgeon and an orthopaedic surgery resident individually measured the hindfoot moment arms and alignment angles. Analysis of variance (ANOVA) testing was used to assess for differences in hindfoot moment arm and hindfoot alignment angle in neutral, internal, and external rotation. Intra- and inter-observer agreement (95% limits) and intra-class correlation coefficients were calculated to assess for intra- and inter-observer reliability. Results: The cohort consisted of 11 (37.9%) males and 18 (62.1%) females, with a mean age of 48.7 (SD=14.7) years and mean body mass index (BMI) of 29.9 (SD=6.6) kg/m2. The mean hindfoot moment arms were 4.6 (SD=6.7) mm, 11.3 (SD=3.4) mm, and -5.4 (SD=6.2) mm in neutral, internal, and external rotation, respectively. The mean hindfoot alignment angles were 4.5 (SD=5.6) degrees, 18.6 (SD=6.8) degrees, and -10.9 (SD=10.6) degrees in neutral, internal, and external rotation, respectively. There was a significant difference in both the hindfoot moment arm (p<0.001) and hindfoot alignment angle (p<0.001) among rotational positions. A strong positive correlation existed between the amount of rotation and both moment arm (r=0.78; p<0.001) and alignment angle (r=0.84; p<0.001). Conclusion: There appears to be significant variability in both the hindfoot moment arm and hindfoot alignment angle with respect to rotation of the patient’s lower extremity. Orthopaedic surgeons should carefully scrutinize limb rotation when making clinical decisions based on the hindfoot moment arm or alignment angle.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1177/2473011420s00373
- https://journals.sagepub.com/doi/pdf/10.1177/2473011420S00373
- OA Status
- gold
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3104944518
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W3104944518Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1177/2473011420s00373Digital Object Identifier
- Title
-
The Effect of Lower Extremity Internal and External Rotation on the Hindfoot Alignment Moment Arm and Hindfoot Alignment AngleWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2020Year of publication
- Publication date
-
2020-10-01Full publication date if available
- Authors
-
Kamil Okroj, Ryan G. Rogero, Daniel Corr, Daniel Fuchs, Brian S. Winters, Joseph T. O’Neil, Rachel Shakked, Steven M. RaikinList of authors in order
- Landing page
-
https://doi.org/10.1177/2473011420s00373Publisher landing page
- PDF URL
-
https://journals.sagepub.com/doi/pdf/10.1177/2473011420S00373Direct link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://journals.sagepub.com/doi/pdf/10.1177/2473011420S00373Direct OA link when available
- Concepts
-
Medicine, Ankle, Valgus, Orthodontics, External rotation, Subtalar joint, Radiography, Internal rotation, Orthopedic surgery, Foot (prosody), Rotation (mathematics), Surgery, Mathematics, Geometry, Philosophy, Mechanical engineering, Engineering, LinguisticsTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| primary_location.source.host_organization_name | SAGE Publishing |
| primary_location.source.host_organization_lineage | https://openalex.org/P4310320017 |
| primary_location.license | cc-by-nc |
| primary_location.pdf_url | https://journals.sagepub.com/doi/pdf/10.1177/2473011420S00373 |
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| primary_location.raw_type | journal-article |
| primary_location.license_id | https://openalex.org/licenses/cc-by-nc |
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| primary_location.is_published | True |
| primary_location.raw_source_name | Foot & Ankle Orthopaedics |
| primary_location.landing_page_url | https://doi.org/10.1177/2473011420s00373 |
| publication_date | 2020-10-01 |
| publication_year | 2020 |
| referenced_works_count | 0 |
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