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Is it possible to define reference values for radiographic parameters evaluating juvenile flatfoot deformity? A

Johannes Hamel1, Hubert Hörterer1,2, Norbert Harrasser3

  • 1Schoen Clinic Munich-Harlaching, Specialist Centre for Foot and Ankle Joint Surgery, Harlachinger Str. 51, 81547, Munich, Germany.

BMC Musculoskeletal Disorders
|December 14, 2020
PubMed
Summary

Establishing reference values for juvenile flatfoot radiographic measurements is challenging. The Talo-metatarsal I angle index (TMTInd), combining Talo-metatarsal I base angle (TMTIB) and Talo-metatarsal I lateral angle (TMT-lat), reliably differentiates flatfeet from normal feet.

Keywords:
Flatfeet - Planovalgus deformityPes planusRadiographic measurementsTalometatarsal index

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Area of Science:

  • Pediatric Orthopedics
  • Radiographic Imaging
  • Biomechanical Analysis

Background:

  • Juvenile flexible flatfoot evaluation relies on various radiographic parameters.
  • Existing reference values are often based on limited studies.
  • Accurate reference values are crucial for diagnosing and managing pediatric flatfoot deformities.

Purpose of the Study:

  • To determine reliable boundary values for common radiographic measurements in juvenile flatfeet.
  • To identify the most effective radiographic parameters for differentiating flatfeet from normal feet.
  • To establish validated reference values for clinical use.

Main Methods:

  • Retrospective analysis of radiographic parameters in 22 normal feet and 19 flatfeet.
  • Measurement of nine key radiographic parameters, including talocalcaneal angles and metatarsal angles.
  • Receiver Operating Characteristic (ROC) curve analysis to determine optimal differentiating thresholds.

Main Results:

  • Four of nine parameters showed low differentiation ability (AUC 0.660-0.819) and could not establish reference values.
  • Reference values were successfully defined for three parameters: TMTInd >(-)31°, TMTIB >(-)7.5°, and TMT-lat >(-)13.5°.
  • The Talo-metatarsal I angle index (TMTInd), a combination of TMTIB and TMT-lat, demonstrated high reliability and validity (AUC 0.998).

Conclusions:

  • Establishing reference values for most radiographic parameters in juvenile flatfeet is difficult.
  • The TMTInd, derived from TMTIB and TMT-lat measurements, is a reliable and valuable tool for distinguishing normal feet from flatfeet.
  • This combined index offers improved diagnostic accuracy for juvenile flatfoot assessment.