Age-dependent associations between spinopelvic alignment and foot axes: A retrospective radiographic study

This study aimed to investigate the relationship between spinopelvic parameters and radiographic foot axes and to examine whether these associations differ across age groups.

This retrospective radiographic study analyzed imaging from patients treated at a university medical center for degenerative or traumatic conditions. Cases with weight-bearing, 2-view foot radiographs and standing lumbar spine radiographs, including the femoral heads, were included. Spinopelvic parameters (lumbar lordosis, pelvic tilt, sacral slope, and pelvic incidence) and radiographic foot axes (including hallux valgus angle, tibiotalar angle, and metatarsal declination angle) were measured, and correlation analyses were per formed with age-based subgroup comparisons.

A total of 46 Caucasian patients (33 females, 13 males) were included (mean age 55.6 ± 18.5 years). Lumbar lordosis showed a significant negative correlation with hallux valgus angle (r = -0.29, P = .015). Sacral slope was negatively correlated with the hallux valgus angle (r = -0.42, P < .001). Pelvic tilt correlated positively with tibiotalar angle (r = 0.34, P = .004) and metatarsal declination angle (r = 0.25, P = .042). Age-stratified analyses demonstrated age-related differences in correlation patterns.

Spinopelvic alignment demonstrates measurable associations with radiographic foot alignment, supporting the concept of the spine-pelvis-lower-limb unit as a biomechanically integrated system. Clinically, these findings suggest that integrated, chain oriented assessment and management strategies (considering both spinal and foot alignment, particularly with aging) may be relevant when evalu ating patients with coexisting spine and foot disorders.   Cite this article as: Roch FE, Kletschka F, Jäckle K, et al. Age-dependent associations between spinopelvic alignment and foot axes: A retrospective radiographic study. Acta Orthop Traumatol Turc., 2025;59(6):379-386.