[Computed tomography demonstration++ of calcaneal morphotypes in plantar arch abnormalities]

CT and MR investigations of the foot generally follow clinics, to confirm the presence of pathologic changes. Plantar arch alterations, which predispose to pain in overload, are not included and thus CT and MR examinations are not usually performed because the patient is not standing. A series of 80 patients (49 males and 31 females, age range: 8-74 years old) was divided according to the presence of clinical signs of plantar arch alterations. Plantar and coronal CT scans were performed according to strict protocols. On plantar scans some patterns were identified, corresponding to the typical signs of conventional radiographs, which are suggestive of flat, cavus and normal feet. On coronal bimalleolar scans, other heel patterns were detected, which are suggestive of medial-concave, varus and orthogonal feet. In our opinion, the above patterns are an example of heel adaptation to plantar arch variability. Especially in the patients with flat feet, the calcaneus-cuboid-metatarsal angle was almost 180 degrees on plantar scans; high agreement was observed, on coronal slices, with the medial-concave heel pattern. The varus morphotype was very frequent among the patients with cavus foot on coronal slices; on plantar scans it corresponded to a calcaneus-cuboid-metatarsal angle (< 180 degrees). CT signs must be accurately described for they help interpret pain related to foot architecture, especially in the patients in whom the possible relationship between symptoms and plantar arch alterations was underestimated.