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Please use this identifier to cite or link to this item: http://hdl.handle.net/1843/59303
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dc.creatorCesarde Cesar Nettopt_BR
dc.creatorThiago Silvapt_BR
dc.creatorShuyuan lipt_BR
dc.creatorNacime Salomao Mansurpt_BR
dc.creatorElijah Auchpt_BR
dc.creatorKevin Dibbernpt_BR
dc.creatorJohn e. Feminopt_BR
dc.creatorDaniel Soares Baumfeldpt_BR
dc.date.accessioned2023-10-09T20:38:25Z-
dc.date.available2023-10-09T20:38:25Z-
dc.date.issued2020-
dc.citation.volume41pt_BR
dc.citation.issue10pt_BR
dc.citation.spage1190pt_BR
dc.citation.epage1197pt_BR
dc.identifier.doi10.1177/1071100720936603pt_BR
dc.identifier.issn10711007pt_BR
dc.identifier.urihttp://hdl.handle.net/1843/59303-
dc.description.resumoBackground: Adult acquired flatfoot deformity (AAFD) is a complex 3-dimensional pathology characterized by peritalar subluxation (PTS) of the hindfoot. For many years, PTS was measured at the posterior facet of the subtalar joint. More recently, subluxation of the middle facet has been proposed as a more accurate and reliable marker of symptomatic AAFD, enabling earlier detection. The objective of this study was to compare the amount of subluxation between the medial and posterior facets in patients with AAFD. Methods: In this institutional review board-approved retrospective comparative study, a total of 76 patients with AAFD(87 feet) who underwent standing weightbearing computed tomography (WBCT) as a standard baseline assessment of their foot deformity were analyzed. Two blinded fellowship-trained orthopedic foot and ankle surgeons with >10 years of experience measured subtalar joint subluxation (as a percentage of joint uncoverage) at the both posterior and middle facets. One of the readers also measured the foot and ankle offset (FAO). PTS measurements were performed at the sagittal midpoint of the articular facets using coronal plane WBCT images. Intra- and interobserver agreement was measured for PTS measurements using the intraclass correlation coefficient (ICC). The intermethod agreement between the posterior and middle facet subluxation was assessed using Spearman’s correlation and bivariate analysis. Paired comparison of the measurements was performed using the Wilcoxon test. A multivariate analysis and a partition prediction model were used to assess influence of PTS measurements on FAO values. P values of <.05 were considered significant. Results: ICCs for intra- and interobserver reliabilities were 0.97 and 0.93, respectively, for posterior and 0.99 and 0.97, respectively, for middle facet subluxation. The intermethod Spearman’s correlation between subluxation of the posterior and middle facets was measured at 0.61. In a bivariate analysis, both measurements were found to be significantly and linearly correlated (P < .0001; R2 = 0.42). Measurements of middle facet subluxation were found to be significantly higher than those for posterior facet subluxation, with a median difference (using the Hodges-Lehman factor) of 17.7% (P < .001; 95% CI, 10.9%-23.6%). We also found that for every 1% increase in posterior facet subluxation there was a corresponding 1.6-fold increase in middle facet subluxation. Only middle facet subluxation measurements were found to significantly influence FAO calculations (P = .003). The partition prediction model demonstrated that a middle facet subluxation value of 43.8% represented an important threshold for increased FAO.Conclusion: This study is the first to compare WBCT measurements of subtalar joint subluxation at the posterior and middle facets as markers of PTS in patients with AAFD. We found a positive linear correlation between the measurements, with subluxation of the middle facet being significantly more pronounced than that of the posterior facet by an average of almost 18%. This suggests that middle facet subluxation may provide an earlier and more pronounced marker of progressive PTS in patients with AAFD.Level of Evidence: Level III, retrospective comparative cohort study.pt_BR
dc.format.mimetypepdfpt_BR
dc.languageengpt_BR
dc.publisherUniversidade Federal de Minas Geraispt_BR
dc.publisher.countryBrasilpt_BR
dc.publisher.departmentMED - DEPARTAMENTO DE APARELHO LOCOMOTORpt_BR
dc.publisher.initialsUFMGpt_BR
dc.relation.ispartofFoot & Ankle International-
dc.rightsAcesso Restritopt_BR
dc.subjectFlatfootpt_BR
dc.subjectAdult acquired flatfoot deformity,pt_BR
dc.subjectAAFDpt_BR
dc.subjectPeritalar subluxationpt_BR
dc.subjectPosterior facetpt_BR
dc.subjectSubtalar Jointpt_BR
dc.subjectWeightbearing CTpt_BR
dc.subjectWBCTpt_BR
dc.subject.otherFlatfootpt_BR
dc.subject.otherSubtalar Jointpt_BR
dc.titleAssessment of posterior and middle facet subluxation of the subtalar joint in progressive flatfoot deformitypt_BR
dc.typeArtigo de Periódicopt_BR
dc.url.externahttps://journals.sagepub.com/doi/10.1177/1071100720936603pt_BR
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