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Reliability of clinically relevant 3D foot bone angles from quantitative computed tomography.

David J Gutekunst1, Lu Liu, Tao Ju

  • 1Applied Kinesiology Laboratory, Program in Physical Therapy, Washington University School of Medicine, St, Louis, MO 63108, USA. gutekunst.david@mayo.edu.

Journal of Foot and Ankle Research
|September 19, 2013
PubMed
Summary

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Accurate 3D foot deformity assessment is crucial for surgical treatment. New landmark-based and automated methods using quantitative computed tomography (QCT) show high reliability for measuring bone angles, improving clinical relevance.

Area of Science:

  • Orthopaedics and Clinical Biomechanics
  • Medical Imaging
  • Computational Anatomy

Background:

  • Accurate assessment of multi-planar foot deformities is essential for surgical treatment and clinical management.
  • Standard radiographs have limitations in quantifying complex foot and ankle deformities.
  • Existing 3D imaging methods using inertial axes lack clinical relevance for established bone angles.

Purpose of the Study:

  • To develop and assess 3D bone-to-bone orientation measurement precision using landmark-based methods on quantitative computed tomography (QCT) bone surface meshes.
  • To evaluate the measurement precision for expert raters and a template-based automated method.
  • To improve the clinical relevance of 3D bone angles in foot deformity assessment.

Main Methods:

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  • Two expert raters placed anatomic landmarks on calcaneus, talus, cuboid, and navicular surfaces across twenty feet over two repetitions.
  • An automated, template-based method was used to record landmarks.
  • Three-dimensional (3D) bone axes were computed, and Cardan sequences generated multi-planar bone-to-bone angles. Angular reliability was assessed using intraclass correlation coefficients (ICCs) and root mean square standard deviation (RMS-SD).

    • Main Results:

    • High intra- and inter-rater ICCs (generally ≥ 0.80) indicated good reliability for landmark-based methods.
    • The automated method demonstrated high agreement with expert raters, comparable to individual rater precision.
    • Intra-rater precision ranged from 1.4 to 6.1°, comparing favorably to uni-planar radiographic precision.

    Conclusions:

    • Landmark-based 3D methods exhibit adequate test-retest reliability for assessing foot deformities.
    • The automated, atlas-based method is a valid and time-saving technique for foot deformity assessment, showing strong agreement with expert raters.
    • These 3D multi-planar quantification techniques hold potential for improved diagnosis of foot and ankle pathologies.