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Assessment of lateral hindfoot pain in acquired flatfoot deformity using weightbearing multiplanar imaging.
Ellis SJ, Deyer T, Williams BR, Yu JC, Lehto S, Maderazo A, Pavlov H, Deland JT. Foot Ankle Int. 2010 May;31(5):361-71.
Quote:
BACKGROUND: The etiology of lateral hindfoot pain in flatfoot deformity can be difficult to assess on plain radiographs. We hypothesized that multiplanar measurements obtained in a fully upright, weightbearing position would reliably demonstrate an increase in lateral hindfoot arthrosis and/or impingement in a cohort of flatfoot patients with lateral hindfoot pain compared to a cohort without pain.
MATERIALS AND METHODS: Ten consecutive patients with flexible flatfoot deformity and lateral hindfoot pain (mean age, 55.5 +/- 13.9) were compared to 10 consecutive patients with flexible deformity but no pain (mean age, 61.0 +/- 8.6). Conventional radiographs and weightbearing multiplanar images were performed on all patients before surgical reconstruction. Flatfoot, hindfoot impingement, and arthrosis parameters were interpreted in a blinded fashion by two musculoskeletal radiologists. Interrater reliability was determined with intraclass correlation coefficients (ICC). All parameters were compared between groups with a Wilcoxon rank sum test (p < 0.05).
RESULTS: A significant increase in posterior facet subtalar arthrosis (p = 0.006) and combined anterior and posterior facet subtalar arthrosis (p = 0.022) was evident in the pain group. Calcaneofibular impingement and calcaneocuboid arthritis were increased in the pain group, but did not reach significance (p = 0.057 and p = 0.067 respectively). The multiplanar imaging parameters demonstrated good (ICC = 0.60 to 0.73) to excellent (ICC >/= 0.74) reliability for most impingement and arthrosis parameters and for many of the standard flatfoot parameters.
CONCLUSION: The results indicate that weightbearing, multiplanar imaging provides a reliable means of assessing lateral pain in patients with flexible flatfoot deformity.
Re: Lateral rearfoot pain in posterior tibial tendon dysfunction
Quote:
MATERIALS AND METHODS: Ten consecutive patients with flexible flatfoot deformity and lateral hindfoot pain (mean age, 55.5 +/- 13.9) were compared to 10 consecutive patients with flexible deformity but no pain (mean age, 61.0 +/- 8.6). Conventional radiographs and weightbearing multiplanar images were performed on all patients before surgical reconstruction. Flatfoot, hindfoot impingement, and arthrosis parameters were interpreted in a blinded fashion by two musculoskeletal radiologists. Interrater reliability was determined with intraclass correlation coefficients (ICC). All parameters were compared between groups with a Wilcoxon rank sum test (p < 0.05).
Maybe a radiographic sign of sinus tarsi syndrome? I don't have the article, but it would be interesting to see what they were looking at in the posterior facet of the STJ. Certainly a high stress area in aquired flatfoot. This assumes that the aquired flat foot is the result of posterior tibial dysfunction causing high medial forefoot loads which cause the medial arch to flatten and then allow the end or range of motion of the STJ at the floor of the sinus tarsi (posterior facet of the STJ) be the anatomical structure that stops pronation. Thus lateral hindfoot (?= sinus tarsi) pain. I wonder how well they describe the anatomy of where the pain is.... prior to surgery.
Lateral rearfoot pain in posterior tibial tendon dysfunction
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