Distal tibiofibular syndesmotic widening in progressive collapsing foot deformity

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dc.creatorElijah Auch
dc.creatorNacime Salomão Barbachan Mansur
dc.creatorThiago Alexandre Alves
dc.creatorChristopher Cychosz
dc.creatorFrancois Lintz
dc.creatorAlexandre Leme Godoy-Santos
dc.creatorDaniel Soares Baumfeld
dc.creatorCesar de Cesar Netto
dc.date.accessioned2023-10-09T21:18:29Z
dc.date.accessioned2025-09-08T23:19:26Z
dc.date.available2023-10-09T21:18:29Z
dc.date.issued2021
dc.format.mimetypepdf
dc.identifier.doi10.1177/1071100720982907
dc.identifier.issn10711007
dc.identifier.urihttps://hdl.handle.net/1843/59306
dc.languageeng
dc.publisherUniversidade Federal de Minas Gerais
dc.relation.ispartofFoot & Ankle International
dc.rightsAcesso Restrito
dc.subjectAnkle Joint
dc.subjectFlatfoot
dc.subject.otherSyndesmosis
dc.subject.otherFlatfoot
dc.subject.otherProgressive collapsing flatfoot deformity
dc.subject.otherWeightbearing computed tomography
dc.subject.otherFoot and ankle offset
dc.titleDistal tibiofibular syndesmotic widening in progressive collapsing foot deformity
dc.typeArtigo de periódico
local.citation.epage775
local.citation.issue6
local.citation.spage768
local.citation.volume42
local.description.resumoBackground: Lateral overload in progressive collapsing foot deformity (PCFD) takes place as hindfoot valgus, peritalar subluxation, and valgus instability of the ankle increase. Fibular strain due to chronic lateral impingement may lead to distraction forces over the distal tibiofibular syndesmosis (DTFS). This study aimed to assess and correlate the severity of the foot and ankle offset (FAO) as a marker of progressive PCFD with the amount of DTFS widening and to compare it to controls. Methods: In this case-control study, 62 symptomatic patients with PCFD and 29 controls who underwent standing weightbearing computed tomography (WBCT) examination were included. Two fellowship-trained blinded orthopedic foot and ankle surgeons performed FAO (%) and DTFS area measurements (mm2). DTFS was assessed semiautomatically on axial-plane WBCT images, 1 cm proximal to the apex of the tibial plafond. Values were compared between patients with PCFD and controls, and Spearman correlation between FAO and DTFS area measurements was assessed. P values of less than .05 were considered significant.Results: Patients with PCFD demonstrated significantly increased FAO and DTFS measurements in comparison to controls. A mean difference of 6.9% (P < .001) in FAO and 10.4 mm2 (P = .026) in DTFS was observed. A significant but weak correlation was identified between the variables, with a Þ of 0.22 (P = .03). A partition predictive model demonstrated that DTFS area measurements were highest when FAO values were between 7% and 9.3%, with mean (SD) values of 92.7 (22.4) mm2.Conclusion: To our knowledge, this was the first study to assess syndesmotic widening in patients with PCFD. We found patients with PCFD to demonstrate increased DTFS area measurements compared to controls, with a mean difference of approximately 10 mm2. A significantly weak positive correlation was found between FAO and DTFS area measurements, with the highest syndesmotic widening occurring when FAO values were between 7% and 9.3%. Our study findings suggest that chronic lateral impingement in patients with PCFD can result in a negative biomechanical impact on syndesmotic alignment, with increased DTFS stress and subsequent widening. Level of Evidence: Level III, retrospective comparative study.
local.publisher.countryBrasil
local.publisher.departmentMED - DEPARTAMENTO DE APARELHO LOCOMOTOR
local.publisher.initialsUFMG
local.url.externahttps://journals.sagepub.com/doi/10.1177/1071100720982907

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