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Ankle Joint Bone Density Distribution Correlates with Overall 3-Dimensional Foot and Ankle Alignment
François Lintz1, Alessio Bernasconi2, Kristian Buedts3
1Department of Foot and Ankle Surgery, Clinique de l'Union, Ramsay Healthcare, Saint Jean, France.
The Journal of Bone and Joint Surgery. American Volume
|August 24, 2023
Summary
Hindfoot alignment significantly impacts bone mineral density distribution in the ankle. Varus alignment increases medial bone density, while valgus alignment increases lateral bone density.
Area of Science:
- Orthopedics
- Radiology
- Biomechanics
Background:
- Altered stress distribution in the lower limb can affect ankle bone mineral density (BMD).
- Weight-bearing cone-beam computed tomography (WBCT) allows for evaluation of spatial BMD distribution.
Purpose of the Study:
- To evaluate the spatial distribution of BMD in the ankle using WBCT.
- To test the hypothesis that BMD distribution is even in normal hindfeet, increased medially in varus hindfeet, and increased laterally in valgus hindfeet.
Main Methods:
- Retrospective comparison of 27 normally aligned hindfeet with 27 valgus and 27 varus-aligned hindfeet.
- Hindfoot alignment quantified using WBCT data; BMD surrogate using mean Hounsfield unit (HU).
- Primary outcome: HU medial-to-lateral ratio (HUR) calculated from tibial and talar half-volumes.
Main Results:
- Significant differences in tibial and talar HUR across hindfoot alignment groups (p < 0.001).
- Varus hindfeet showed increased tibial and talar HUR (greater medial density); valgus hindfeet showed decreased HUR (greater lateral density).
- All hindfoot measurements significantly correlated with tibial and talar HUR (p < 0.001).
Conclusions:
- Hindfoot alignment is correlated with medial-to-lateral BMD distribution in the tibia and talus.
- Varus alignment is associated with increased medial bone density, while valgus alignment is associated with increased lateral bone density.
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