Wearable Integrated Volitional Control Electrical Stimulation Device as Treatment for Paresis of the Upper Extremity in Early Subacute Stroke Patients: A Randomized Controlled Non-inferiority Trial.

OBJECTIVE: To investigate the effect of a wearable integrated volitional control electrical stimulation (WIVES) device that has been developed as more compact and simpler to use in daily life compared with conventional integrated volitional control electrical stimulation (IVES) devices. DESIGN: Randomized controlled non-inferiority trial. SETTING: Convalescent rehabilitation ward. PARTICIPANTS: Patients with paresis of the upper extremity (UE) after early subacute stroke (N=20). INTERVENTIONS: Eligible patients were randomized to receive IVES treatment or WIVES treatment for 8 hours per day for 28 days in daily living, in addition to standard rehabilitation treatment. In both groups, the extensor digitorum communis on the affected side was the target muscle for stimulation. MAIN OUTCOME MEASURE: Primary outcomes were assessed with Fugl-Meyer Assessment of the UE (FMA-UE) before and after treatment. Non-inferiority was determined with a specified margin of non-inferiority. RESULTS: Twenty patients completed the trial (IVES group: n=10, WIVES group: n=10). FMA-UE improved in both groups. The mean change in FMA-UE was 4.7 for the IVES group and 6.0 for the WIVES group (P>.05, 95% confidence interval: -6.73 to 4.13). The mean difference between the groups was 1.3, and the upper 95% confidence interval did not exceed the non-inferiority margin. CONCLUSION: The effectiveness of WIVES treatment is non-inferior to that of IVES treatment. As a portable device, IVES may facilitate the use of affected upper extremities in daily living and may help improve paresis of the UE.

Kinesiophysiological analysis associated with changes in subjective intensities in belt electrode-skeletal muscle electrical stimulation: a prospective exploratory study.

[Purpose] Belt electrode-skeletal muscle electrical stimulation (B-SES) is a novel electrical muscle stimulation treatment that causes less pain and discomfort and induces contraction in a wider skeletal muscle area than conventional electrodes. However, the stimulation intensity depends on patients' subjectivity. In the present study, B-SES and an expiratory gas device were combined to analyze the kinesiophysiological data associated with changes in subjective intensity. [Participants and Methods] Seventeen healthy participants were recruited. The subjective intensities were set to four conditions (weak, normal, strong, and maximum tolerated intensity), and the stimulation was performed in each condition in the "metabolic mode" (frequency, 4 Hz; pulse width, 250 µs). The primary outcome was metabolic equivalents (METs), and this data were compared for each condition. [Results] METs generated by B-SES were 2.0 (1.0) for weak intensity, 2.7 (1.2) for normal intensity, 3.9 (1.3) for strong intensity, and 5.0 (1.3) for the tolerance limit intensity; differences detected between all subjective intensities were statistically significant. [Conclusion] These findings show that objective intensities of >3 METs, as recommended in rehabilitation prescriptions, can be achieved when the subjective intensity is set at strong or maximum tolerated. Treatment with B-SES may provide a viable alternative to therapeutic exercise.

The inter-prefectural regional disparity of healthcare resources and representative surgical procedures in orthopaedics and general surgery: a nationwide study in Japan during 2015-2019.

BACKGROUND: Few reports have examined the localized regional disparity in representative surgical procedures in orthopaedics and general surgery globally. This study aimed to clarify the inter-prefectural regional disparity and relationships between healthcare resources and representative surgical procedures using a nationwide database in Japan. METHODS: The number of medical specialists in orthopaedics, general surgery, and anaesthesiology, as well as the number of hospitals, and the incidence of representative surgical procedures in orthopaedics and general surgery were evaluated annually per 100,000 inhabitants/people by prefecture in Japan during 2015-2019. Medium-sized regional disparities were evaluated using the Gini coefficient. Correlation coefficients were calculated for the defined variables and ageing rate. We also compared the urban and rural regional disparities in all study variables. RESULTS: The annual average number/incidence and Gini coefficients were 110.6 and 0.11 for femur fracture surgery, 106.3 and 0.09 for cholecystectomy, 14.2 and 0.11 for orthopaedic surgeon specialists, 17.6 and 0.09 for general surgeon specialists, 5.9 and 0.13 for anaesthesiology specialists, and 8.1 and 0.21 for hospitals, respectively. The correlation coefficients by the incidence of femur fracture surgery were 0.74 for orthopaedic surgeon specialists (p < 0.001), 0.63 for hospitals (p < 0.001), and 0.62 for the ageing rate (p < 0.001); those by the incidence of cholecystectomy were 0.60 for general surgeon specialists (p < 0.001) and 0.59 for hospitals (p < 0.001). The number/incidence of orthopaedic surgeon specialists, hospitals, femur fracture surgery, and cholecystectomy, as well as the ageing rate, were significantly higher in rural prefectures than in urban prefectures (p < 0.05). CONCLUSIONS: Inter-prefectural regional disparity was small, although certain items were unevenly distributed in the rural prefectures, which is contrary to our expectations. Higher prevalence was recognised in rural prefectures due to the higher ageing rate; however, supply and demand are balanced. This study provides basic data for healthcare policy development in a medium-sized community. LEVEL OF EVIDENCE: III.

Foot orthosis treatment improves physical activity but not muscle quantity in patients with concurrent rheumatoid arthritis and sarcopenia.

OBJECTIVES: Foot impairment in rheumatoid arthritis (RA) may exacerbate sarcopenia from physical inactivity because of foot pain while walking. The present study aimed to investigate the prevalence of sarcopenia in patients with RA-associated foot impairment, and whether treatment with a foot orthosis improved physical activity and muscle quantity. METHODS: Thirty-two patients with RA were diagnosed as sarcopenic or nonsarcopenic, and the prevalence of sarcopenia was determined. Eleven patients with sarcopenia were treated with a foot orthosis. The following parameters were compared between baseline and after 6 months of treatment: physical activity (walking, moderate-intensity activity, and vigorous-intensity activity), foot pain while walking, Health Assessment Questionnaire (HAQ) score, and body composition parameters, including muscle quantity. RESULTS: Sarcopenia was present in 25/32 patients (78.1%). The use of a foot orthosis improved walking activity (p = .02), foot pain while walking (p = .02), and HAQ score (p = .02). However, there were no significant changes in moderate- or vigorous-intensity activities or body composition parameters, including muscle quantity. CONCLUSION: Patients with RA-associated foot impairment had a high rate of sarcopenia. Treatment with a foot orthosis increases light-intensity physical activity such as walking, but does not enhance moderate-to-vigorous-intensity activities or increase muscle quantity.

The influence of hallux valgus and flatfoot deformity on metatarsus primus elevatus: A radiographic study.

BACKGROUND: Metatarsus primus elevatus (MPE), a dorsal elevation of the first metatarsal in relation to the lesser metatarsals on lateral-view radiographs, is an indicator of hallux rigidus. The angle between the articular surfaces of the base of the first metatarsal and the anterior part of the medial cuneiform (M1C1A) reflects the sagittal instability of the first tarsometatarsal (TMT) joint. MPE may also indicate instability of the first metatarsal. The purpose of this study was to identify the influence of hallux valgus (HV) and flatfoot (FF) deformities on measurements obtained from first metatarsal-related radiographic images. METHODS: Standing radiographic images of 134 feet were investigated. In dorsoplantar-view radiographs, HV and intermetatarsal angles were evaluated. The position of the medial sesamoid was classified with a grading system (Hardy score). In lateral-view radiographs, MPE, M1C1A, and Meary's angle were measured. The subjects were divided into 4 groups: the normal group (G1), HV(-)FF(-); the HV group (G2), HV(+)FF(-); the FF group (G3), HV(-)FF(+); and the dual group (G4), HV(+)FF(+). The radiographic parameters were compared among the groups. RESULTS: MPE in the HV patients (G2 and G4) was less than that in the non-HV participants (G1 and G3). MPE in G4 was less than that in G3. The odds ratios of the Hardy score were higher in G2, G3 and G4 than in G1. The ratios were higher in the FF patients (G3 and G4) than in the non-FF participants (G1 and G2) and were higher in G4 than in G2. CONCLUSIONS: FF affects sesamoid dislocation, and the combination of HV and FF further increases sesamoid dislocation. Combined with M1C1A and the Hardy score, MPE may be a useful indicator of three-dimensional instability of the first TMT joint. First TMT joint-related operations may be considered for severe HV treatment in G4 patients.

Early stage and small medial osteochondral lesions of the talus in the presence of chronic lateral ankle instability: A retrospective study.

BACKGROUND: In chronic lateral ankle instability (CLAI), the instability of the ankle joint results in repeated microtrauma to the articular cartilage. How the lesion condition or stage is affected by the presence of lateral instability in medial osteochondral lesions of the talus (OLT) is unclear. We aimed to examine whether CLAI is associated with the size and staging of medial OLT on radiographs, magnetic resonance (MR) images, and arthroscopy. METHODS: Forty-five patients with medial OLTs in 45 ankles were reviewed. Radiographs were assessed for damage and lesion classification. The tibio-talar tilting angle (TTA) was measured. The patients were divided into two groups: the CLAI group and the stable group. The lesion classification on radiographs, MR images, and arthroscopy, and size on MR images were statistically compared. RESULTS: The CLAI group had a mean TTA of 8.15 ± 3.41°, whereas the stable group had a mean TTA of 2.24 ± 1.64°. The CLAI group had a lower clinical score than the stable group at the initial visit to our clinic. The CLAI group presented with lesions of significantly shorter longitudinal and transverse diameters. Stages of medial OLT on radiographs, MR images, and arthroscopic evaluation were earlier in the CLAI group than those in the stable group. CONCLUSIONS: Patients with CLAI presented in the early stages of OLT and had significantly smaller lesions than those without CLAI. The patients without CLAI may be selected for surgery at an early phase.

Motion analysis of operating a balance exercise assist robot system during forward and backward movements.

[Purpose] Stand-and-ride personal mobility devices controlled by movements of the user's center of gravity are used for balance training. We aimed to describe the physical activity required to operate this type of mobility device. [Participants and Methods] Eleven healthy males performed the following tasks: 1) moving their center of gravity forward or backward while standing on the floor (control task) and, 2) moving the mobility device forward or backward by moving their center of gravity (experimental task). [Results] We observed that the displacement of the center of gravity and the center of pressure, as well as angular displacements of the hips and knee joints, and maximum muscle activities of the biceps femoris, the medial head of the gastrocnemius and peroneus longus muscles were lesser during the experimental than during the control task. The distance moved by the device was significantly greater than the displacement of the user's center of gravity during the experimental task. [Conclusion] We observed that moving the device forward or backward required lesser physical activity than that required to shift the user's center of gravity forward or backward while standing on the floor. Additionally, we observed that even a small displacement of the user's center of gravity produced a large displacement of the device. We concluded that during balance training, the greater and more easily perceived movement of the mobility device would provide helpful feedback to the user.

Relationship Between Grading With Magnetic Resonance Imaging and Radiographic Parameters in Posterior Tibial Tendon Dysfunction.

The objective of the present study was to elucidate the relationship between the state of the posterior tibial tendon (PTT) on magnetic resonance images and foot deformity. The cases included 34 feet in 27 patients with PTT deformity and the controls included 18 feet in 12 patients who had undergone magnetic resonance imaging for other foot diseases. The PTT was closely examined on the magnetic resonance images and classified using the Conti classification. The control feet with no injury to the PTT were classified as grade 0. The talonavicular coverage angle, lateral talo-first metatarsal angle, medial cuneiform to fifth metatarsal height, calcaneal pitch angle, and varus-valgus angle were measured as radiographic parameters for flatfoot deformation, and the relation between the Conti classification and each parameter was examined statistically. A significant difference was observed in the talonavicular coverage angle between grade 0 and the other grades; the lateral talo-first metatarsal angle between grade 0 and the other grades and between grades 1 and 3; the medial cuneiform to fifth metatarsal height among grades 0, 2, and 3 and grades 1, 2, and 3; the calcaneal pitch angle between grades 1 and 3; and the varus-valgus angle among grades 0, 2, and 3 and between grades 1 and 3. Eversion of the forefoot was observed, along with an advanced collapse in the medial longitudinal arch, from an early stage of PTT injury.

Examination of the Correlation Between Foot Morphology Measurements Using Pedography and Radiographic Measurements.

Pedography provides excellent visualization of the footprint. However, the correlation between the footprint images and radiographic measures has not been thoroughly evaluated. Therefore, the objectives of our study were to examine the correlation between the pedography-based measures of foot morphology and radiographic measurements and to propose reference values for the diagnosis of flatfoot using footprint imaging. The plantar footprints of 100 right feet were photographed using a pedography standing platform. The sole and arch areas were measured to calculate the footprint index (FPI). The lateral talar-first metatarsal angle (LTM) and calcaneal pitch angle (CP) were measured on standing lateral radiographs, and the talonavicular coverage angle was measured on frontal radiographs. The Pearson moment correlation between the FPI and radiography-based measures was calculated. The area under the receiver operating characteristic curve was calculated using an LTM of <-4° as the identifying criterion of flatfoot. The sensitivity and specificity of FPI were calculated for LTM values <-4°. The FPI correlated with the LTM (y = -17.964 ± 52.644x, R = 0.588) and CP (y = 9.2304 ± 27.739x, R = 0.659) but not with the talonavicular coverage angle (y = 26.01 ± 15.78x, R = 0.207). The area under the receiver operating characteristic curve was 0.753, with a cutoff FPI of 0.208, yielding a sensitivity of 0.462 and specificity of 0.934 for flatfoot identification. Pedography could provide an easy screening tool for flatfoot, with an FPI cutoff of 0.208, yielding a specificity of 93.4%.

Hindfoot alignment at one year after total knee arthroplasty.

PURPOSE: It has previously been found that valgus hindfoot alignment (HFA) improves 3 weeks following total knee arthroplasty (TKA) for varus knee osteoarthritis (OA). In the present study, HFA was evaluated prior to TKA, as well as 3 weeks and 1 year following TKA. Using these multiple evaluations, the chronological effects of TKA on HFA were investigated. METHODS: The study included 71 patients (73 legs) who underwent TKA for varus knee OA. Radiograph examinations of the entire limb and hindfoot were performed in the standing position prior to TKA, as well as 3 weeks and 1 year following TKA. The varus-valgus angle was used as an indicator of HFA in the coronal plane. Patients were divided into two groups according to the preoperative varus-valgus angle: a hindfoot varus group (varus-valgus angle <76°) and a hindfoot valgus group (varus-valgus angle ≥76°). The changes in the varus-valgus angle were evaluated and compared in both groups. RESULTS: In the hindfoot valgus group, the mean ± standard deviation varus-valgus angle significantly declined from 80.5 ± 3.1° prior to TKA to 78.6 ± 3.7° 3 weeks following TKA and 77.1 ± 2.7° 1 year following TKA. However, in the hindfoot varus group, the mean varus-valgus angle prior to TKA (72.7 ± 2.6°) did not differ significantly from the mean varus-valgus angles 3 weeks (72.3 ± 3.3°) or 1 year (73.5 ± 3.0°) following TKA. CONCLUSIONS: HFA improved chronologically in legs with hindfoot valgus as a result of the alignment compensation ability of the hindfoot following TKA. However, no improvement was noted in legs with hindfoot varus because the alignment compensation ability of the hindfoot had been lost. The patients with hindfoot varus should be attended for ankle pain in the outpatient clinic after TKA. LEVEL OF EVIDENCE: III.

Diagnostic Characteristics of Standard Radiographs and Magnetic Resonance Imaging of Ruptures of the Tibialis Posterior Tendon.

The present study aimed to diagnose complete rupture (CR) and longitudinal rupture (LR) of the posterior tibial tendon (PTT) from the magnetic resonance imaging findings in patients with PTT dysfunction and to analyze and compare the radiographs from each group to identify radiographic indicators related to the progression of PTT injury that would allow the radiographic diagnosis of CR. We evaluated 32 feet in 27 patients with PTT dysfunction (mean age 66.5, range 49 to 82, years). Radiographs were used to acquire weightbearing anteroposterior images of the foot, which were used to measure the talonavicular coverage angle. Lateral images of the foot were also acquired with the patients in the standing position. These were used to measure the lateral talometatarsal angle, calcaneal pitch angle, and medial cuneiform-fifth metatarsal height. From the axial MRI findings, the patients were divided into a CR group and an LR group, and the radiographic attributes of the CR group were analyzed. Of the 32 feet in 27 patients, 12 feet (37.5%) in 11 patients displayed CR and 20 feet (62.5%) in 18 patients displayed LR. The talonavicular coverage angle was 48.3° ± 17.3° in the CR group and 33.6° ± 13.6° in the LR group (p = .012), and the talometatarsal angle was -28.8° ± 22.5° in the CR group and -25.4° ± 14.4° in the LR group (p = .596). The calcaneal pitch angle was 10.4° ± 6.7° in the CR group and 10.2° ± 8.0° in the LR group (p = .935). Finally, the medial cuneiform-fifth metatarsal height was -4.2 ± 7.1 mm in the CR group and 2.1 ± 4.7 mm in the LR group (p = .005). When a medial cuneiform-fifth metatarsal height of ≤0 mm or talonavicular coverage angle of ≥50° was used as the diagnostic criterion for CR on weightbearing radiographs, the sensitivity was 71.4%, specificity 88.9%, and diagnostic accuracy 81.3%; hence, we believe these to be satisfactory diagnostic criteria for CR.

Alteration of hindfoot alignment after total knee arthroplasty using a novel hindfoot alignment view.

This study examined the coronal alignment of the hindfoot in varus osteoarthritis of the knee before and after total knee arthroplasty (TKA) in 100 legs using a novel imaging method. We categorized the preoperative hindfoot alignment into varus (30 legs) and valgus (70 legs) groups; imaging of the hindfoot was conducted preoperatively and postoperatively, and the varus-valgus angle (VVA) was measured as the hindfoot alignment. The femorotibial angle improved significantly after TKA. We found that the VVA improved significantly after TKA in the hindfoot valgus group (P<0.001), but not in the varus group (P=0.554), and we speculate that the hindfoot alignment in the valgus group improved as a result of a residual compensatory capacity in the hindfoot.

One-Leg Robotic-Assisted Gait Training Efficiently Improves Gait Independence for Acute Stroke Hemiplegic Patients: A Prospective Pilot Study.

ABSTRACT: Welwalk is a one-leg robotic-assisted gait system for stroke hemiplegic patients. This study examined the feasibility and efficacy of gait training using Welwalk (Welwalk training) for hemiplegic patients in the early phase after stroke onset, via cooperation between acute care and rehabilitation hospitals. Seven acute stroke patients (mean number of days from onset = 7.9) with severe lower extremity paralysis participated. Patients underwent Welwalk training for 40 min/d, 5 d/wk in an acute care hospital, then 7 d/wk in a rehabilitation hospital with a seamless transition. Functional Independence Measure scores for walking were assessed weekly. The endpoint was reaching Functional Independence Measure walk score of 5 (supervision level). The primary outcome was improvement efficiency of Functional Independence Measure walk, which was the increase in Functional Independence Measure walk score divided by the number of weeks required. Functional Independence Measure walk score for all patients improved from 1.1 to 5 ( P = 0.01, r = 0.96). The mean number of weeks to achieve Functional Independence Measure walk score of 5 was 5 wks, and the improvement efficiency of Functional Independence Measure walk had a mean value of 0.9. No adverse events were reported during Welwalk training. Hemiparetic patients' gait independence may be safely and rapidly improved by starting Welwalk training in the early phase after stroke onset.

A home-based low-intensity resistance exercise programme with supervision for secondary sarcopenia in a patient with established rheumatoid arthritis: A case report.

Patients with established rheumatoid arthritis (RA) are at risk of developing secondary sarcopenia. Both pharmacological and exercise interventions are essential for treatment. However, for such patients, exercise loads may lead to the progression of joint destruction and worsening of pain. The purpose of this report was to assess the feasibility of a home-based, low-intensity resistance exercise programme. The case was a 70-year-old female patient with sarcopenia secondary to RA. She was diagnosed with RA at 57 years of age and began medication, maintaining remission of disease activity. However, she did not exercise habitually and was relatively inactive in her daily life. Furthermore, she had kinesiophobia associated with her RA-related symptoms. We suggested implementing a home-based low-intensity resistance exercise programme >3 months, with the goal of exercising the lower extremities daily. The patient was asked to self-monitor using an exercise diary and attend monthly outpatient visits for repeat counselling and feedback. As a result, she was able to perform the exercise programme safely with high compliance, improving her kinesiophobia as well as physical inactivity, although her skeletal muscle mass did not change. Regular exercise and increased physical activity may help prevent the onset of sarcopenia. These results demonstrate the feasibility of implementing our exercise programme and support its potential for preventing the progression of sarcopenia. While questions remain in terms of treating sarcopenia, we believe that our findings will lead to the establishment of an exercise programme for patients with sarcopenia secondary to established rheumatoid arthritis.

Accurate diagnosis of sarcopenia without using a body composition analyzer in a convalescent rehabilitation ward.

Hishikawa N, Sawada K, Shono S, Sakurai M, Yokozeki M, Maeda H, Ohashi S, Ueshima K, Mikami Y. Accurate diagnosis of sarcopenia without using a body composition analyzer in a convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2023; 14: 26-32. Objective: The Asian Working Group for Sarcopenia 2019 recommends diagnosing sarcopenia without using a body composition analyzer and initiating treatment early. The present study aimed to investigate the accuracy of diagnosing sarcopenia without a body composition analyzer in a convalescent rehabilitation ward. Methods: Eighty-five patients admitted to a convalescent rehabilitation ward were included, and sarcopenia diagnoses were performed with and without a body composition analyzer. To assess the accuracy of diagnosing sarcopenia without using a body composition analyzer, sensitivity, specificity, positive predictive value, and negative predictive value were calculated relative to sarcopenia diagnoses made using a body composition analyzer. Results: The sensitivity of the technique for diagnosing sarcopenia was 0.94, specificity was 0.77, positive predictive value was 0.86, and negative predictive value was 0.90. Conclusion: The accuracy of diagnosing sarcopenia without using a body composition analyzer was high. However, this technique may miss sarcopenia cases in patients with increased calf circumference due to adipose tissue and/or edema.

Effect of Foot Orthosis Treatment on Quality of Life in Secondary Sarcopenia Patients with Rheumatoid Arthritis-Related Foot Impairment.

Objectives: Patients with rheumatoid arthritis (RA)-related foot impairment have a high rate of sarcopenia. Treatment using a foot orthosis (FO) enables not only a reduction in pain while walking but also an increase in physical activity, helping to prevent further loss of muscle mass. However, the primary goal of treating RA is to maximize patients' long-term quality of life (QOL). We investigated whether FO treatment both increases physical activity and improves QOL. Methods: Among 31 patients with RA-related foot impairment, 15 with sarcopenia were treated with an FO for 6 months. Foot-specific QOL (measuring using the Self-Administered Foot Evaluation Questionnaire), foot pain, activities of daily living, and physical activity (walking-intensity activity and moderate- to vigorous-intensity activity) were compared before treatment and after 6 months of treatment. Results: Ten patients who completed 6 months of follow-up were analyzed. Significant QOL improvements were found in the Pain and Pain-Related category and the Physical Functioning and Daily Living category (P = 0.02-0.04); however, no significant changes were found in the Social Functioning, General Health and Well-Being, or Shoe-Related categories (P = 0.09-0.21). Foot pain and activities of daily living significantly improved (P = 0.01-0.04). Physical activity significantly increased for walking-intensity activity (P = 0.04) but did not change for moderate- to vigorous-intensity activity (P = 1.00). Conclusions: FO treatment in patients with RA-related foot impairment and sarcopenia increased light-intensity physical activity such as walking and improved physical QOL.

Reproducibility of radiographic methods for assessing longitudinal tarsal axes Part 2: Severe cavus or flatfoot study.

INTRODUCTION: Calcaneal pitch angle and Meary's angle are commonly used to assess longitudinal foot arches on lateral-view radiographs. The aim of this study was to examine and evaluate the radiographic longitudinal foot arch measurement methods with the best intraobserver and interobserver reliabilities for patients with (1) severe cavus deformity and (2) severe flatfoot deformity. METHODS: Standing radiographic images of 22feet with severe cavus foot deformity and 49feet with severe flatfoot deformity were obtained to measure the longitudinal axes of the talus, first metatarsal, calcaneus and plantar surface, which were defined using six, five, four and three different methods, respectively, selected from previous reports. Intraobserver and interobserver correlation coefficients were calculated. RESULTS: The results are generally consistent with those of Part 1. The best intraobserver and interobserver correlation coefficients for the tarsal axes were obtained using methods involving a line bisecting the angle formed by the lines tangential to the superior and inferior margins of the talus, a line connecting the centre of the first metatarsal head and the midpoint of the visualized base of the first metatarsal, and a line drawn tangential to the inferior surface of the calcaneus. For the plantar axis, a method that used the horizontal plane (as a reference axis) was regarded as the best approach. CONCLUSIONS: The aforementioned methods were considered to be optimal for the radiographic assessment of longitudinal foot arches in patients with severe cavus or flatfoot deformity. This study may contribute to the more accurate assessment of any foot deformity.

Reproducibility of radiographic methods for assessing longitudinal tarsal axes: Part 1: Consecutive case study.

INTRODUCTION: Calcaneal pitch angle and Meary's angle are commonly used to assess longitudinal foot arches on lateral-view radiographs. However, the methods used to obtain the talar, first metatarsal, calcaneal, and plantar axes differ across multiple reports, and no study has evaluated the reproducibility of these approaches. The aim of this study was to determine the most reproducible methods for radiographically evaluating longitudinal axes. METHODS: Standing radiographic images of 40 feet from 21 consecutive outpatients were obtained to measure longitudinal axes of the talus, first metatarsal, calcaneus and plantar surface, which were defined using six, five, four and three different methods, respectively, selected from previous reports. Intraobserver and interobserver correlation coefficients were calculated. RESULTS: The best intraobserver and interobserver correlation coefficients for the talar, first metatarsal, and calcaneal axes were obtained using methods involving a line bisecting the angle formed by the lines tangential to the superior and inferior margins of the talus, a line connecting the centre of the first metatarsal head and the midpoint of the visualized base of the first metatarsal, and a line drawn tangential to the inferior surface of the calcaneus, respectively. For the plantar axis, a method that used the horizontal plane (as a reference axis) was regarded as the best approach, although intraobserver and interobserver correlation coefficients could not be calculated because all values were zero. CONCLUSIONS: The aforementioned methods were considered to be optimal for the radiographic assessment of longitudinal foot arches. This study could contribute to more accurate assessments of foot deformities.