目的:扁平足和静脉足的病因是多原因且有争议的。到目前为止,无文献报道距下关节矢状形态与足对齐的关系。这项研究的目的是探讨距下对齐是否会影响脚的构型。
方法:从2017年1月到2020年1月,我们在扁平足组中包括109英尺,Cavus组95英尺,在这项回顾性比较研究中,对照组为104英尺。Gissane角和跟骨后关节面倾角代表距下关节的矢状形态。米里的角度,跟骨俯仰角,距骨俯仰角反映了脚的对准。它们是在负重脚X射线中测量的。通过Mann-WhitneyU检验比较不同组的角度。我们使用Spearman的相关分析计算了距下关节矢状对齐与足对齐之间的相关性。计算了观察者间和观察者内的可靠性。
结果:吉萨角,跟骨后关节面倾角,米里的角度,距骨俯仰角,跟骨俯仰角在三组间有显著差异。Gissane角与Meary角具有极好的相关性(r=0.850,p<0.0001),距骨俯仰角(r=-0.825,p<0.0001),与跟骨俯仰角具有良好的相关性(r=0.638,p<0.0001)。跟骨后关节面倾角与迈里角有很好的相关性(r=-0.902,p<0.001),距骨俯仰角(r=0.887,p<0.0001),与跟骨俯仰角具有良好的相关性(r=-0.702,p<0.0001)。所有射线照相测量的观察者间和观察者内可靠性都很好。
结论:距下关节具有较大的Gissane角和较水平的跟骨后关节面角倾向于具有较高的足弓,反之亦然。这项研究的启示是,扁平足和cavus足的畸形可能与距下畸形有关。
OBJECTIVE: The etiology of flatfoot and cavus foot is multicausal and controversial. So far, no literature reports the relationship between the sagittal morphology of subtalar joint and the
alignment of foot. The purpose of this study was to explore whether the subtalar
alignment would influence the configuration of foot.
METHODS: From January 2017 to January 2020, we included 109 feet in the flatfoot group, 95 feet in the cavus group, and 104 feet in the control group in this retrospective comparative study. The Gissane angle and calcaneal posterior articular surface inclination angle represented the sagittal morphology of the subtalar joint. Meary\'s angle, calcaneal pitch angle, and talar pitch angle reflected the
alignment of foot. They were measured in the weightbearing foot X-rays. The angles in different groups were compared via Mann-Whitney U test. We calculated the correlation between the sagittal
alignment of subtalar joint and the
alignment of foot using Spearman\'s correlation analysis. Interobserver and intraobserver reliability were calculated.
RESULTS: The Gissane angle, calcaneal posterior articular surface inclination angle, Meary\'s angle, talar pitch angle, and calcaneal pitch angle were significantly different in the three groups. The Gissane angle had an excellent correlation with the Meary\'s angle (r = 0.850, p < 0.0001), and the talar pitch angle (r = -0.825, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = 0.638, p < 0.0001). The calcaneal posterior articular surface inclination angle had an excellent correlation with the Meary\'s angle (r = -0.902, p < 0.001), and the talar pitch angle (r = 0.887, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = -0.702, p < 0.0001). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent.
CONCLUSIONS: A subtalar joint with a larger Gissane angle and a more horizontal calcaneal posterior articular surface angle tended to have a higher foot arch and vice versa. The inspiration from this study was that the deformities of flatfoot and cavus foot may relate to the subtalar deformity.