1Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Medical University, Xi'an 710068, China; 2Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an 710054, China; 3Spine Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an 710054, China
Abstract：Objective To explore a new method of radiological and measuring the posterior foot line of force based on X-ray films, and to study the evaluation accuracy of flatfoot patients.Methods Prospective study. Twenty-eight patients (40 feet) with flatfeet(flatfoot group) and 20 volunteers (40 feet, control group) admitted to foot and ankle surgery department of Honghui Hospital of Xi'an Jiaotong University, were taken from January to December 2018. The Saltzman position shooting stand independently designed by our department has been used to take the hindfoot alignment X-ray at 10°, 15°, 20°, 25°, 30° respectively. The differences in age, gender, gender, and BMI were compared between the two groups.The modified tibio-hindfoot angle (THA) at standard Saltzman position (shooting at 20°) and the consistency with the van Dijk method and the modified van Dijk method were evaluated. The THA results of the three measurement methods with the weighted CT measurements reported in the literature were compared. The visibility of tibiotalar joint space of all imaging data at five projection angles were observed; and the consistency of the modified THA method at different projection angles were evaluated.Results There was no significant difference in age, gender, sides, or BMI between the two groups (all P values＞0.05). The intra-group consistency of the three measurement methods was excellent,and the intra-group consistency was the best in modified THA group(intraclass correlation coefficient was 0.928). The results of modified THA method were significantly larger than those of van Dijk method and modified van Dijk method.The mean THA in standard Saltzman view in normal people were significantly different between the three evaluation methods (F=0.092, P＜0.01). There was no significant different between the results of modified THA method and the weight-bearing CT (P＞0.05). The tibiotalar space in the normal group were visible in all cases at 10°, 15°, 20° (100%); and visible in some cases at 25° (70%); and invisible in all cases at 30° (0%). In the flatfoot group, the tibiotalar space were visible in all cases at 10° (100%); and in some cases at 15° and 20° (80%); and invisible in all cases at 25° and 30° (0%). In the normal group, the modified THA was 4.84±1.81° at 10°, 4.96±1.77° at 15°, 4.94±2.04° at 20°. No significant difference was found between the three groups (F=1.570, P＞0.05). In the flatfoot group, the modified THA of 18 feet, which was visible at 10°, 15° and 20°, was 13.58°±3.57° at 10°, 13.62°±3.83° at 15° and 13.38°±4.06° at 20°. There was no significant difference between the three groups (F=0.197, P＞0.05).Conclusions The modified THA evaluation method is easy to operate and has high inter-group and intra-group consistency. It can be used to evaluate hindfoot alignment. For patients with flatfeet, the 10° position view and modified THA measurement can be used to evaluate the hindfoot valgus conditions.
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2020, Vol. 25 
