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Related Concept Videos

Bones of the Lower Limb: Tibia and Fibula01:10

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The tibia is the main weight-bearing bone of the lower leg. It is larger than the fibula with which it is paired. The tibia is also the second longest bone in the body and is located right below the skin. The proximal end of the tibia forms the medial and the lateral condyle, which articulates with the condyles of the femur to form the knee joint. Between the articulating surfaces is the irregular elevated area known as the intercondylar eminence that serves as the inferior attachment point for...
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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Plain Radiographs Underestimate Tibiotalar Tilt in Progressive Collapsing Foot Deformity.

Jaeyoung Kim1, Rami Mizher1, Constantine A Demetracopoulos1

  • 1Foot and ankle service, Hospital for Special Surgery, New York, NY, USA.

Foot & Ankle International
|April 30, 2026
PubMed
Summary
This summary is machine-generated.

Weightbearing CT scans reveal significant underestimation of ankle valgus in progressive collapsing foot deformity (PCFD) when using standard X-rays. Radiographs miss anterior joint deformities, potentially impacting surgical planning for PCFD patients.

Keywords:
CTPCFDWBCTankleflatfoottalar tiltvalgusweightbearingx-ray

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Area of Science:

  • Orthopedics
  • Radiology
  • Biomechanics

Background:

  • Accurate tibiotalar alignment assessment is crucial for progressive collapsing foot deformity (PCFD) staging and surgical planning.
  • Plain radiographs have limitations due to their 2D nature and variable beam angulation, potentially leading to inaccurate alignment evaluation.
  • Weightbearing CT (WBCT) offers a 3D view, potentially improving the accuracy of tibiotalar alignment assessment.

Purpose of the Study:

  • To quantify discrepancies in tibiotalar tilt (TT) between plain radiographs (XRs) and WBCT.
  • To compare the prevalence of significant valgus tilt (≥4°) between XRs and WBCT.
  • To identify radiographic features associated with underrecognized deformity on XRs.

Main Methods:

  • Retrospective review of 138 PCFD patients who underwent both WBCT and ankle XRs.
  • Measurement of tibiotalar tilt (TT), medial distal tibial angle (MDTA), and talus-ground surface angle (Tal-GS) on both modalities.
  • Comparison of TT and valgus tilt prevalence, with Bland-Altman plots for agreement and logistic regression for discrepancy predictors.

Main Results:

  • Mean TT underestimated by 63% on XRs (1.5°) compared to WBCT (4.1°).
  • Significant valgus tilt (≥4°) prevalence was 10.1% on XRs vs. 37.7% on WBCT.
  • Anterior tibiotalar tilt on WBCT predicted XR-WBCT discrepancy (OR 33.0, P<.001), indicating underrecognition on radiographs.

Conclusions:

  • Plain radiographs significantly underestimate valgus tibiotalar tilt in PCFD patients compared to WBCT.
  • Limited visualization of the anterior ankle joint on XRs leads to underrecognition of deformity.
  • Optimizing XR techniques may improve preoperative planning, as WBCT is not universally available.