Torsional Deformity Significantly Impacts Lateral Ankle Radiographic Imaging Parameters

Background Optimal lateral ankle imaging is important for the diagnosis and treatment of multiple ankle conditions. The effects of limb deformity on lateral ankle imaging are not well described and are clarified in this osteological study. Materials and methods We utilized an osteological collection and imaged all specimens after the first positioning of the talus in the lateral position and positioning the tibia and fibula to match. We then measured the relative positions of the tibia and fibula and their widths to calculate standard ratios. All measurements were evaluated for reliability using intra-class correlation coefficients. Multiple regression analysis determined how patient characteristics, tibial torsion, and medial proximal tibial angle affected various lateral ankle imaging ratios. Results The intra-class correlation coefficient was excellent for all measurements. In the multiple regression analysis, all five imaging ratios had at least one statistically significant outcome. The anterior tibiofibular interval (ATFI)-tibial width (TW) ratio (ATFI:TW) had only one association with sex and had the lowest standard deviation. All other parameters had variation with tibial torsion and/or medial proximal tibia angle (MPTA). The mean ATFI was 1.06 ± 0.21 cm and 1.19 ± 0.23 cm for females and males, respectively. Conclusions Patient sex and tibial torsion impacted the fidelity of lateral imaging parameters. ATFI:TW may pose the greatest utility given its minimal association with deformity parameters and low standard deviation.