Top

Journal of Foot and Ankle Research

Published in:

Open Access 01-12-2021 | Research

New anatomical reference systems for the bones of the foot and ankle complex: definitions and exploitation on clinical conditions

Authors: Michele Conconi, Alessandro Pompili, Nicola Sancisi, Alberto Leardini, Stefano Durante, Claudio Belvedere

Published in: Journal of Foot and Ankle Research | Issue 1/2021

Abstract

Background

A complete definition of anatomical reference systems (ARS) for all bones of the foot and ankle complex is lacking. Using a morphological approach, we propose new ARS for these bones with the aim of being highly repeatable, consistent among individuals, clinically interpretable, and also suited for a sound kinematic description.

Methods

Three specimens from healthy donors and three patients with flat feet were scanned in weight-bearing CT. The foot bones were segmented and ARS defined according to the proposed approach.

To assess repeatability, intra class coefficients (ICC) were computed both intra- and inter-operator.

Consistency was evaluated as the mean of the standard deviations of the ARS position and orientation, both within normal and flat feet.

Clinical interpretability was evaluated by providing a quantification of the curvature variation in the medial-longitudinal and transverse arches and computing the Djiann-Annonier angle for normal and flat feet from these new ARS axes.

To test the capability to also provide a sound description of the foot kinematics, the alignment between mean helical axes (MHA) and ARS axes was quantified.

Results

ICC was 0.99 both inter- and intra-operator.

Rotational consistency was 4.7 ± 3.5 ° and 6.2 ± 4.4° for the normal and flat feet, respectively; translational consistency was 4.4 ± 4.0 mm and 5.4 ± 2.9 mm for the normal and flat feet, respectively. In both these cases, the consistency was better than what was achieved by using principal axes of inertia.

Curvature variation in the arches were well described and the measurements of the Djiann-Annoier angles from both normal and flat feet matched corresponding clinical observations.

The angle between tibio-talar MHA and ARS mediolateral axis in the talus was 12.3 ± 6.0, while the angle between talo-calcaneal MHA and ARS anteroposterior axis in the calcaneus was 17.2 ± 5.6, suggesting good capability to represent joint kinematics.

Conclusions

The proposed ARS definitions are robust and provide a solid base for the 3-dimensional description of posture and motion of the foot and ankle complex from medical imaging.

Available only for authorised users

Brown JA, Gale T, Anderst W. An automated method for defining anatomic coordinate systems in the hindfoot. J Biomech. 2020;109:109951. https://doi.org/10.1016/j.jbiomech.2020.109951.CrossRefPubMedPubMedCentral

Fitzpatrick C, FitzPatrick D, Auger D, Lee J. 1 a tibial-based coordinate system for three2 dimensional data. Knee. 2007;14(2):133–7. https://doi.org/10.1016/j.knee.2006.11.001.CrossRefPubMed

Cappozzo A, Catani F, Della Croce U, Leardini A. Position and orientation in space of bones during movement: anatomical frame definition and determination. Clin Biomech 1995;10(4):171–178. https://doi.org/10.1016/0268-0033(95)91394-T.

Andriacchi TP, Alexander EJ. Studies of human locomotion: past, present and future. J Biomech. 2000. https://doi.org/10.1016/S0021-9290(00)00061-0.

Leardini A, Stebbins J, Hillstrom H, Caravaggi P, Deschamps K, Arndt A. ISB recommendations for skin-marker-based multi-segment foot kinematics. J Biomech. 2021;125:110581. https://doi.org/10.1016/j.jbiomech.2021.110581.CrossRefPubMed

Lundgren P, Nester C, Liu A, Arndt A, Jones R, Stacoff A, et al. Invasive in vivo measurement of rear-, mid- and forefoot motion during walking. Gait & Posture. 2008;28(1):93–100. https://doi.org/10.1016/j.gaitpost.2007.10.009.CrossRef

Leardini A, Benedetti MG, Berti L, Bettinelli D, Nativo R, Giannini S. Rear-foot, mid-foot and fore-foot motion during the stance phase of gait. Gait & Posture. 2007;25(3):453–62. https://doi.org/10.1016/j.gaitpost.2006.05.017.CrossRef

Rouhani H, Favre J, Crevoisier X, Jolles BM, Aminian K. A comparison between joint coordinate system and attitude vector for multi-segment foot kinematics. J Biomech. 2012;45(11):2041–5. https://doi.org/10.1016/j.jbiomech.2012.05.018.CrossRefPubMed

Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, et al. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. J Biomech. 2002;35(4):543–8. https://doi.org/10.1016/S0021-9290(01)00222-6.CrossRefPubMed

10.

Beimers L, Maria Tuijthof GJ, Blankevoort L, Jonges R, Maas M, van Dijk CN. In-vivo range of motion of the subtalar joint using computed tomography. J Biomech. 2008. https://doi.org/10.1016/j.jbiomech.2008.02.020.

11.

Della Croce U, Leardini A, Chiari L, Cappozzo A. Human movement analysis using stereophotogrammetry. Gait & Posture. 2005;21(2):226–37. https://doi.org/10.1016/j.gaitpost.2004.05.003.CrossRef

12.

Lenz AL, Strobel MA, Anderson AM, Fial AV, MacWilliams BA, Krzak JJ, et al. Assignment of local coordinate systems and methods to calculate tibiotalar and subtalar kinematics: a systematic review. J Biomech. 2021;120:110344. https://doi.org/10.1016/j.jbiomech.2021.110344.CrossRefPubMed

13.

Hayes A, Tochigi Y, Saltzman CL. Ankle morphometry on 3D-CT images. Iowa Orthop J. 2006;26:1–4.PubMedPubMedCentral

14.

Sheehan FT, Seisler AR, Siegel KL. In vivo Talocrural and subtalar kinematics: a non invasive 3D dynamic MRI study. Foot Ankle Int. 2007;28(3):323–35. https://doi.org/10.3113/FAI.2007.0323.CrossRefPubMed

15.

Imai K, Ikoma K, Maki M, Kido M, Tsuji Y, Takatori R, et al. Features of hindfoot 3D kinetics in flat foot in ankle-joint maximal dorsiflexion and plantarflexion. J Orthop Sci. 2011;16(5):638–43. https://doi.org/10.1007/s00776-011-0103-x.CrossRefPubMed

16.

Fassbind MJ, Rohr ES, Hu Y, Haynor DR, Siegler S, Sangeorzan BJ, et al. Evaluating foot kinematics using magnetic resonance imaging: from maximum plantar flexion, inversion, and internal rotation to maximum dorsiflexion, eversion, and external rotation. J Biomech Eng. 2011;133(10):104502. https://doi.org/10.1115/1.4005177.CrossRefPubMedPubMedCentral

17.

Parr WCH, Chatterjee HJ, Soligo C. Calculating 1 the axes of rotation for the subtalar and talocrural joints using 3D bone reconstructions. J Biomech. 2012;45(6):1103–7. https://doi.org/10.1016/j.jbiomech.2012.01.011.CrossRefPubMed

18.

Caputo AM, Lee JY, Spritzer CE, Easley ME, DeOrio JK, Nunley JA, et al. In vivo kinematics of the Tibiotalar joint after lateral ankle instability. Am J Sports Med. 2009;37(11):2241–8. https://doi.org/10.1177/0363546509337578.CrossRefPubMedPubMedCentral

19.

Yamaguchi S, Sasho T, Kato H, Kuroyanagi Y, Banks SA. Ankle and subtalar kinematics during dorsiflexion-plantarflexion activities. Foot Ankle Int. 2009;30(4):361–6. https://doi.org/10.3113/FAI.2009.0361.CrossRefPubMed

20.

Fukano M, Fukubayashi T. Changes in talocrural and subtalar joint kinematics of barefoot versus shod forefoot landing. J Foot Ankle Res. 2014;7(1):42. https://doi.org/10.1186/s13047-014-0042-9.CrossRefPubMedPubMedCentral

21.

Gutekunst DJ, Liu L, Ju T, Prior FW, Sinacore DR. Reliability of clinically relevant 3D foot bone angles from quantitative computed tomography. J Foot Ankle Res. 2013;6(1). https://doi.org/10.1186/1757-1146-6-38.

22.

Brown KM, Bursey DE, Arneson LJ, Andrews CA, Ludewig PM, Glasoe WM. Consideration of digitization precision when building local coordinate axes for a foot model. J Biomech. 2009;42(9):1263–9. https://doi.org/10.1016/j.jbiomech.2009.03.013.CrossRefPubMed

23.

Belvedere C, Giacomozzi C, Carrara C, Lullini G, Caravaggi P, Berti L, et al. Correlations between weight-bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot. J Foot Ankle Res. 2020;13(1):64. https://doi.org/10.1186/s13047-020-00431-x.CrossRefPubMedPubMedCentral

24.

Coburn JC, Upal MA, Crisco JJ. Coordinate systems for the carpal bones of the wrist. J Biomech. 2007;40(1):203–9. https://doi.org/10.1016/j.jbiomech.2005.11.015.CrossRefPubMed

25.

Wang B, Roach KE, Kapron AL, Fiorentino NM, Saltzman CL, Singer 1 M, et al. Accuracy and feasibility of high-speed dual fluoroscopy and model-based tracking to measure in vivo ankle arthrokinematics. Gait & Posture. 2015. https://doi.org/10.1016/j.gaitpost.2015.03.008.

26.

Yoshioka N, Ikoma K, Kido M, Imai K, Maki M, Arai Y, et al. Weight-bearing three5 dimensional computed tomography analysis of the forefoot in patients with flatfoot deformity. J Orthop Sci. 2016;21(2):154–8. https://doi.org/10.1016/j.jos.2015.12.001.CrossRefPubMed

27.

Nichols JA, Roach KE, Fiorentino NM, Anderson AE. Subject-specific axes of rotation based on Talar morphology do not improve predictions of Tibiotalar and subtalar joint kinematics. Ann Biomed Eng. 2017;45(9):2109–21. https://doi.org/10.1007/s10439-017-1874-9.CrossRefPubMedPubMedCentral

28.

Carrara C, Caravaggi P, Belvedere C, Leardini A. Radiographic angular measurements of the foot and ankle in weight-bearing: a literature review. Foot Ankle Surg. 2020;26(5):509–17. https://doi.org/10.1016/j.fas.2020.03.013.CrossRefPubMed

29.

Ortolani M, Leardini A, Pavani C, Scicolone S, Girolami M, Bevoni R, et al. Angular and linear measurements of adult flexible flatfoot via weight bearing CT scans and 3D bone reconstruction tools. Sci Rep. 2021;11(1):16139. https://doi.org/10.1038/s41598-021-95708-x.CrossRefPubMedPubMedCentral

30.

Koo TK, Li MY. A guideline of selecting and reporting Intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–63. https://doi.org/10.1016/j.jcm.2016.02.012.CrossRefPubMedPubMedCentral

31.

Uhl JF, Chahim M, Allaert FA. Static foot disorders: a major risk factor for chronic venous disease? Phlebology. 2012;27(1):13–8. https://doi.org/10.1258/phleb.2011.010060.CrossRefPubMed

32.

Woltring HJ. Data processing and error analysis. In: Cappozzo A, Berme N, editors. Biomechanics of Human Movement. 1991. p. 203–37.

33.

Carrara C, Belvedere C, Caravaggi P, Durante S, Leardini A. Techniques for 3D foot bone orientation angles in weight-bearing from cone-beam computed tomography. Foot Ankle Surg. 2021. https://doi.org/10.1016/j.fas.2020.03.013.

Title: New anatomical reference systems for the bones of the foot and ankle complex: definitions and exploitation on clinical conditions
Authors: Michele Conconi
Alessandro Pompili
Nicola Sancisi
Alberto Leardini
Stefano Durante
Claudio Belvedere
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: Journal of Foot and Ankle Research / Issue 1/2021
Electronic ISSN: 1757-1146
DOI: https://doi.org/10.1186/s13047-021-00504-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

New anatomical reference systems for the bones of the foot and ankle complex: definitions and exploitation on clinical conditions

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

COVID-19 lockdown disrupts support networks integral to maintaining foot health: a mixed-methods study

Knowledge and perceptions of cardiopulmonary resuscitation amongst New Zealand podiatrists: a web-based survey

Children should be seen and also heard: an explorative qualitative study into the influences on children’s choice of footwear, their perception of comfort and the language they use to describe footwear experiences

Knowledge, attitude, practice and associated factors of health professionals towards podoconiosis in Gamo zone, Ethiopia, 2019

Patient and clinician experiences and opinions of the use of a novel home use medical device in the treatment of peripheral vascular disease - a qualitative study

Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases