Enhanced Precision for Deformity Correction Planning: Revision of Values for the Vitruvian Foot Quadrilateral with...

The introduction of the 'Vitruvian' Foot concept in 2019 established initial parameter measurements of the 'normal' foot quadrilateral (FQ) in the sagittal plane. This effort had been aimed at increasing precision when analysing alignment abnormalities in post-traumatic and congenital foot deformities, so as to more accurately guide corrective treatment planning with osteotomies. The current study enhances the prior, existing data with an expanded normal cohort. We also offer a case report that describes the successful application of the revised reference angles for our analysis and correction of a congenital foot deformity in a 29-year-old woman.

Included in the present analysis were 100 normal radiographs (78 patients). We followed the FQ delineated by our previous studies, which uses the distance between the posterior process of the talus and the anterior edge of the articular surface of the talus body (points a and b, respectively) to form the talus joint line (TJL). The FQ is then transcribed in the sagittal plane, anchored by the dual weight-bearing apices created by the junctures of the TJL and the most definitively plantar points of (1) the first metatarsal head (c) and (2) the posterior calcaneus (d). Reference angles were designated as: The anatomic lateral talometatarsal angle (aLTMA, ∠bcd), the mechanical talometatarsal angle (mLTMA, ∠bac), and the lateral heel angle (LHA, ∠acd). Additionally, we measured ∠dab, ∠abc, and ∠cda, as well as the proportional values of line lengths bc:ab (k1), cd:ab (k2), and ad:ab.

The resulting, revised measurements and standard deviations (SDs) were as follows: ∠abc = 144.5 ± 3.7 degrees, ∠bcd = 32.6 ± 1.9 degrees, ∠cda = 79.1 ± 3.7 degrees, ∠dab = 103.8 ± 3.4 degrees, k1 = 3.02 ± 0.24, k2 = 3.83 ± 0.31, and k3 = 1.62 ± 0.17.

We expanded the dataset of previous publications and to corroborate and more accurately define upon the concept of the normalised 'Vitruvian' foot. The larger sample size allowed refinements in the previously established reference values. Though the newer calculations showed only slight referential changes, there was a noticeable tightening of the SD over the previously published reference lines and angles (RLAs) measurements.

The updated normalised parameters can offer the surgeon a reliable framework to enhance precision in foot deformity correction planning.

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Solomin L, Ukhanov K, Kirienko A, et al. Enhanced Precision for Deformity Correction Planning: Revision of Values for the Vitruvian Foot Quadrilateral with Demonstrative Case Report. Strategies Trauma Limb Reconstr 2025;20(2):72-81.