The horizontal calcaneofibular ligament: a sign of hindfoot valgus on ankle MRI
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SCIENTIFIC ARTICLE
The horizontal calcaneofibular ligament: a sign of hindfoot valgus on ankle MRI Sangoh Lee 1,2 & Ines Oliveira 2 & Ian Pressney 2 & Matthew Welck 2 & Asif Saifuddin 2,3 Received: 5 March 2019 / Revised: 5 November 2019 / Accepted: 10 November 2019 # ISS 2019
Abstract Objective Hindfoot valgus malalignment has been assessed on coronal MRI by the measurement of the tibio-calcaneal (TC) angle and apparent moment arm (AMA). This study aimed to determine if the calcaneofibular ligament (CFL) angle could be used as a further marker of hindfoot valgus malalignment on routine non-weight-bearing ankle MRI. Material and methods One hundred ninety-five consecutive 3-T ankle MRI studies were identified from the hospital PACS system. The TC and CFL angles could be measured in 155 cases (78%), and the AMA on 153 cases. Results The study group comprised 56 males and 72 females with a mean age of 46 years (range 4–89 years). In 27 patients, both ankles had been imaged. The Pearson correlation between the TC and CFL angles was −0.43, with a corresponding p value of 0.001 indicating a strong negative correlation between the TC and CFL angles. The CFL angle was significantly lower in those with hindfoot valgus (113 ± 14) compared with those without (123° ± 15°) (p = 0.001). The optimal cut-off point of the CFL angle for hindfoot valgus was ≤119°, with a sensitivity and specificity of 66% and 63% respectively. The Pearson correlation between the CFL angle and AMA was −0.10, with a corresponding p value of 0.21 indicating a weak negative correlation that did not reach statistical significance. Conclusion Hindfoot valgus as estimated by the increased TC angle on coronal non-weight-bearing ankle MRI is associated with a reduced CFL angle on sagittal MR images, but is not associated with AMA. Therefore, a horizontal orientation of the CFL on sagittal MR images may be a further useful sign of hindfoot valgus. Keywords Hindfoot . Valgus . Tibio-calcaneal angle . Lower limb . MRI
Introduction Hindfoot valgus can be secondary to congenital (e.g., hindfoot coalition) or acquired (e.g., tibialis posterior dysfunction and inflammatory or osteoarthritis) causes [1, 2]. Pre-existing pes * Sangoh Lee [email protected] * Ines Oliveira [email protected] * Matthew Welck [email protected] * Asif Saifuddin [email protected] 1
Department of Clinical Imaging, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
2
Royal National Orthopaedic Hospital NHS Trust, Brockley Hill Stanmore HA7 4LP, UK
3
Everlight Radiology, Level 6, West, 350 Euston Rd, London, UK
planus, obesity, hypertension, diabetes, and participation in high-impact sports have also been regarded as risk factors [1]. The severity of this malalignment can alter patient management, and early identification is important to achieve optimal outcomes and reduce the risk of subtalar osteoarthritis. Traditionally, hindfoot valgus has been assessed on weightbearing hindfoot alignment and long axial view radiographs by assessing the tibio-calc
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