Assessing the subtalar joint: the Brodén view revisited

Area of Science:

• Orthopedic imaging
• Radiology
• Biomechanics

Background:

• Subtalar joint instability can lead to chronic pain and dysfunction.
• The Brodén view, a type of subtalar inversion stress radiography, is commonly used to assess this condition.
• Helical CT offers advanced imaging but its utility in evaluating subtalar instability requires clarification.

Purpose of the Study:

• To prospectively compare the diagnostic accuracy of conventional stress radiography (Brodén view) and helical CT in evaluating subtalar inversion instability.
• To determine if helical CT can reliably detect subtalar tilt, a key indicator of instability.

Main Methods:

• 10 patients with unilateral subtalar instability underwent both plain stress radiography and helical CT with inversion stress views.
• The contralateral asymptomatic ankle served as a control.
• Subtalar tilt was assessed on both imaging modalities.

Main Results:

• Subtalar tilt was evident in all patients using conventional stress radiography.
• Helical CT failed to demonstrate tilting in most cases, with findings limited to the posteromedial subtalar joint in subluxated instances.
• These results contrast with previous reports on the utility of the Brodén view.

Conclusions:

• Conventional stress radiography is effective for demonstrating subtalar tilt in cases of instability.
• Helical CT, in its current application, does not appear to be a sensitive tool for detecting subtalar instability or tilt.
• The findings question the Brodén view's utility as a primary screening tool for subtalar instability when using helical CT.