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AIM: The purpose of this study was to identify the individuals with symptomatic flat foot and find out a correlation between the foot pain and radiological parameters. Background: The talo-firstmetatarsal (TFM) angle, calcanealpitch (CP) angle, medial cuneiform-fifth metatarsal height on the lateral weight-bearing foot radiographs, and talar head uncoverage distance on the anteroposterior weight-bearing feet radiographs are the radiographic parameters used to assess the pes planus. The association of radiological parameters with symptomatic foot pain has always been a doubt. Assessment of superiority of one radiological parameter over the other is always controversial. Hence, we conducted a study to assess the correlation of symptomatic flat foot with CPangle and talo-1stmetatarsal angle. MATERIALS AND METHODS: We studied a total of 91 patients with symptomatic flat foot. The symptoms associated with flat foot were assessed using Foot Health Status Questionnaire. Based on the findings of this enquiry, they were objectively divided into mild, moderate, and severe which were then correlated with CP angle and TFM angles. Conclusion: In our study, we found that there is positive correlation between TFM angle and level of foot pain and negative correlation between CP angle and level of foot pain. Among the two, TFM angle showed higher correlation when compared to CP angle.

Background: We aimed to investigate the effect of Haglund deformity size on insertional Achilles tendinopathy (IAT) using a new measurement system and identify independent risk factors of IAT with Haglund deformity. Methods: We reviewed medical records of patients with IAT and age/sex-matched patients with diagnoses other than Achilles tendinopathy. Radiographs were reviewed to identify posterior heel spur, plantar heel spur, and intra–Achilles tendon calcification, and to measure Fowler-Philip angle, calcaneal pitch angle, and Haglund deformity angle and height. We introduced a new measurement system for Haglund deformity angle and height and evaluated its intraobserver and interobserver reliability. Multivariate logistic regression analysis was performed to identify independent risk factors of IAT with Haglund deformity. Results: Fifty patients (55 feet) were enrolled in the study group, equaling the size of the age/sex-matched control group. The new Haglund deformity measurement system showed excellent intraobserver and interobserver reliability. No significant differences between the 2 groups were noted in Haglund deformity angle and height: 6.0 degrees in both groups, and 3.3 mm vs 3.2 mm in the study and control group, respectively. The study group had significantly higher calcaneal pitch angle, incidence of posterior heel spur, plantar heel spur, and intra–Achilles tendon calcification: 5.2 vs 23.1 degrees (P =.044), 81.8% vs 36.4% (P <.001), 76.4% vs 34.5% (P =.003), and 67.3% vs 5.5% (P <.001), respectively. Multivariate logistic regression analysis identified independent risk factors of IAT: posterior heel spur (OR = 3.650, 95% CI = 1.063, 12.532), intra–Achilles tendon calcification (OR = 55.671, 95% CI = 11.233, 275.905), and increased calcaneal pitch angle (OR = 6.317). Conclusion: Based on our results, the actual size of Haglund deformity as we have reliably measured was not associated with IAT, suggesting a routine Haglund deformity resection may be unnecessary in the surgical treatment of IAT. If patients with Haglund deformity have posterior heel spur, intra–Achilles tendon calcification, or increased calcaneal pitch angle, a higher chance of IAT can be predicted. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Objective:To compare the radiological parameters of the normal population with the patients with Haglund’s syndrome (HS) and to seek a correlation between pain scores and radiological parameters in patients with HS.Methods:Thirty-one patients surgically treated for HS (Haglund group) and 36 healthy subjects free of hindfoot pathology seen in consultation for any other foot pathologies (control group) were included in the study. Demographic data of the patients were acquired, and radiological measurements such as; Fowler Philip Angle (FPA), lateral talus-first metatarsal angle (LTFMA), and Calcaneal pitch angle (CPA) were recorded. The visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) scores of the patients in the Haglund group were assessed.Results:Mean CPA, FPA, and LTFMA in the Haglund group were 23.88±4.6, 58.16±5.7, and 4.92±1.88, respectively, and the same recordings in the control group were 21.16±4.81, 59.1±4.3, and 4.25±2.57, respectively. CPA differences between Haglund and control groups were statistically significant (p=0.021). The average values of the VAS and AOFAS scores of the patients in the Haglund group were 8.45±1.06 and 47.4±7.58, respectively. There was no correlation between the scores and the radiological measurements of patients in the Haglund group.Conclusion:Radiological assessments are widely debated. Many studies support our results that measurements defined for the morphology of calcaneus are not associated with the Haglund’s disease severity. Increase in the CPA is found to be related to HS. This may be explained by the extension of the calcaneus to irritate the Achilles tendon and cause heel pain.

Objective: To compare the radiological parameters of the normal population with the patients with Haglund's syndrome (HS) and to seek a correlation between pain scores and radiological parameters in patients with HS. Methods: Thirty-one patients surgically treated for HS (Haglund group) and 36 healthy subjects free of hindfoot pathology seen in consultation for any other foot pathologies (control group) were included in the study. Demographic data of the patients were acquired, and radiological measurements such as; Fowler Philip Angle (FPA), lateral talus-first metatarsal angle (LTFMA), and Calcaneal pitch angle (CPA) were recorded. The visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) scores of the patients in the Haglund group were assessed. Results: Mean CPA, FPA, and LTFMA in the Haglund group were 23.88±4.6, 58.16±5.7, and 4.92±1.88, respectively, and the same recordings in the control group were 21.16±4.81, 59.1±4.3, and 4.25±2.57, respectively. CPA differences between Haglund and control groups were statistically significant (p=0.021). The average values of the VAS and AOFAS scores of the patients in the Haglund group were 8.45±1.06 and 47.4±7.58, respectively. There was no correlation between the scores and the radiological measurements of patients in the Haglund group. Conclusion: Radiological assessments are widely debated. Many studies support our results that measurements defined for the morphology of calcaneus are not associated with the Haglund's disease severity. Increase in the CPA is found to be related to HS. This may be explained by the extension of the calcaneus to irritate the Achilles tendon and cause heel pain. [ABSTRACT FROM AUTHOR]

Flatfoot is a common foot deformity that seriously affects the quality of life. The aim of this study is to develop an accurate and noninvasive method for the diagnosis of flatfoot based on B-mode ultrasound. In this study, 51 patients (the flatfoot group) and 43 healthy subjects (the control group) were included. The plantar fascia angle, a new measurement for use in the diagnosis of flatfoot is proposed, as determined using B-mode ultrasound. For comparison, the calcaneal pitch angle and medial cuneiform height were also measured using lateral X-radiography, based on traditional diagnostic methods. The intraclass correlation values of the plantar fascia angle, the calcaneal pitch angle, and the medial cuneiform height were all more than 0.95, and there is a moderate correlation (r = 0.51) between the medial cuneiform height and the calcaneal pitch angle, and an excellent correlation (r = 0.85) between the plantar fascia angle and the calcaneal pitch angle. The optimal cutoff value, sensitivity, and specificity for medial cuneiform height in flatfoot diagnosis were 12.8 mm, 93.0%, and 54.9%, respectively. The optimal cutoff value, sensitivity, and specificity for plantar fascia angle in flatfoot diagnosis were 9.8°, 97.7%, and 94.1%, respectively. The proposed plantar fascia angle has good sensitivity and specificity in diagnosing flatfoot, therefore supplying a new approach for the noninvasive diagnosis of flatfoot.

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Background: The purpose of this study was to evaluate the reliability and reproducibility of three commonly used radiographic measures for plantar surface angles.Methods: The calcaneal angle (CA), calcaneal pitch angle (CPA), and length-height index (LHI) was measured by three independent examiners on two occasions on lateral foot radiographs. Intra- and inter-rater correlations were calculated using a general linear estimate model and post-hoc tests for repeated measures. Bland-Altman's plots with limits of agreement were used for observer differences in scores.Results: The intra-class correlations for the CA ranged from 0.91 to 0.94, for the CPA from 0.93 to 0.98, and for the LHI from 0.96 to 0.97. The inter-class correlations were 0.80 for CA, 0.83 for CPA and 0.93 for LHI.Conclusions: The results of this study strongly suggest that the length-height index was the most consistent and reliable measure for arch height.Level Of Evidence: Diagnostic Level II, validity. [ABSTRACT FROM AUTHOR]

Objective: To compare the calcaneal pitch angle (CPA) values measured on direct lateral radiographs of feet, and the modified projection area per length squared (PAL), which was calculated as a new method for the evaluation of the medial longitudinal arch (MLA) of the foot.Material and Methods: Direct lateral radiographs of patients who had weightbearing feet radiographies for any reason except trauma were retrospectively obtained from the archives. Direct lateral radiographs of the feet were printed and a transparent sheet was placed on it. A straight line was drawn between the most plantar process of the calcaneus and the head of the first metatarsal bone for the calculation of the PAL of the MLA. Two semilunar arcs were drawn upon this straight line. PAL1 and PAL2 were estimated using a point-counting technique. The CPA, lateral talo-calcaneal angles (LTCA), and talo-first metatarsal angles (TFMA) were measured. The correlations between PAL1, PAL2 of right and left feet and CPA, LTCA, and TFMA were explored.Results: Fifty patients (27 females, 23 males) with a mean age of 40.12 (4-78) years were evaluated. Significant correlations were detected between PAL1, PAL2 and CPA, and TFMA for both right and left feet (p

Introduction: Haglund's deformity (a prominence in the posterosuperior aspect of the calcaneum) is a known cause of posterior heel pain. Surgery is reserved for patients after failed conservative treatment. Zadek osteotomy is a dorsal-closing wedge osteotomy that reduces the posterior heel prominence. Zadek osteotomy is becoming a favored procedure, however, there are still relatively few studies focusing on patient-reported outcomes. Our main aim was to assess patient-reported outcomes following the Zadek osteotomy in refractory Haglund's deformity. Our secondary aim was to evaluate the correlation between patient outcomes and changes in their pre and postoperative Fowler-Philip and calcaneal pitch angles., Methods: We conducted a retrospective review of 19 patients (20 heels) who underwent Zadek osteotomy by a single surgeon at a tertiary hospital over six years. Patient-reported outcomes were collected preoperatively and at 12 months postoperatively using the validated Manchester-Oxford foot questionnaire (MOXFQ) scoring system. We also calculated the difference in their pre and postoperative Fowler-Philip angles and calcaneal pitch using the picture archiving communication system., Results: There was an average improvement of 108 points in the MOXFQ score at 12 months (P<0.05). There was no statistically significant change in calcaneal pitch. However, the Fowler-Phillip angle dropped with an average of 11.4 º (P<0.05). A decrease in the Fowler-Philip angle does improve patient-related outcome measurement scores, however, the relationship is not directly proportional with "r" measured at 0.23., Conclusion: Our results show that Zadek osteotomy is a useful procedure to consider in patients with symptomatic refractory Haglund's deformity, with an improvement in patient outcomes at 12 months. However, further studies are needed to give stronger evidence for the efficacy of this procedure and its radiological correlations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Xu et al.)

Flatfoot is a common foot deformity that seriously affects the quality of life. The aim of this study is to develop an accurate and noninvasive method for the diagnosis of flatfoot based on B-mode ultrasound. In this study, 51 patients (the flatfoot group) and 43 healthy subjects (the control group) were included. The plantar fascia angle, a new measurement for use in the diagnosis of flatfoot is proposed, as determined using B-mode ultrasound. For comparison, the calcaneal pitch angle and medial cuneiform height were also measured using lateral X-radiography, based on traditional diagnostic methods. The intraclass correlation values of the plantar fascia angle, the calcaneal pitch angle, and the medial cuneiform height were all more than 0.95, and there is a moderate correlation (r = 0.51) between the medial cuneiform height and the calcaneal pitch angle, and an excellent correlation (r = 0.85) between the plantar fascia angle and the calcaneal pitch angle. The optimal cutoff value, sensitivity, and specificity for medial cuneiform height in flatfoot diagnosis were 12.8 mm, 93.0%, and 54.9%, respectively. The optimal cutoff value, sensitivity, and specificity for plantar fascia angle in flatfoot diagnosis were 9.8°, 97.7%, and 94.1%, respectively. The proposed plantar fascia angle has good sensitivity and specificity in diagnosing flatfoot, therefore supplying a new approach for the noninvasive diagnosis of flatfoot., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jiang, Zhang, Ren and Qian.)

Objective: To compare the calcaneal pitch angle (CPA) values measured on direct lateral radiographs of feet, and the modified projection area per length squared (PAL), which was calculated as a new method for the evaluation of the medial longitudinal arch (MLA) of the foot. Material and Methods: Direct lateral radiographs of patients who had weightbearing feet radiographies for any reason except trauma were retrospectively obtained from the archives. Direct lateral radiographs of the feet were printed and a transparent sheet was placed on it. A straight line was drawn between the most plantar process of the calcaneus and the head of the first metatarsal bone for the calculation of the PAL of the MLA. Two semilunar arcs were drawn upon this straight line. PAL1 and PAL2 were estimated using a point-counting technique. The CPA, lateral talo-calcaneal angles (LTCA), and talo-first metatarsal angles (TFMA) were measured. The correlations between PAL1, PAL2 of right and left feet and CPA, LTCA, and TFMA were explored. Results: Fifty patients (27 females, 23 males) with a mean age of 40.12 (4-78) years were evaluated. Significant correlations were detected between PAL1, PAL2 and CPA, and TFMA for both right and left feet (p<0.05). Conclusion: A significant correlation was detected between the modified PAL method as a new technique and the standard CPA method for MLA evaluation. The PAL method is suggested as a simple and practical method for MLA evaluation. [ABSTRACT FROM AUTHOR]

Haglund's deformity is a symptomatic posterosuperior deformity of the heel. The lateral radiograph of the ankle will show a prominent, large, posterosuperior part of the calcaneus, which can be measured using the Fowler and Philips angle (FPA, the angle between the posterior and plantar surface of the calcaneus) and the calcaneal pitch angle (CPA, the angle between the sole of the foot and the plantar part of the calcaneus). Although these angles are commonly used, these radiographic angle measurements have never shown a relationship with Haglund's deformity. In 78 patients (51% male) with symptomatic Haglund's deformity and a control group of 100 patients (41% male) with no heel complaints, we measured the FPA and CPA on weightbearing lateral radiographs of the foot. Using an unpaired t tests, no significant difference was found between the 2 groups in the FPA ( p = .40). We measured a significant difference in the CPA between the Haglund group and the control group ( p = .014). Subgroup analysis showed that this difference was mainly found in females ( p < .00), with no significant difference seen in the males ( p < .48). Females with Haglund's deformity will have a greater CPA than will females without Haglund's deformity. The CPA showed a difference between the Haglund and non-Haglund groups, although mainly in females. Although the evidence from our study is limited, it would be interesting to study the CPA further, because it implicates the verticalization of the calcaneus. This change in position results in extra traction on the Achilles tendon and can eventually cause tendinitis and bursitis. Radiographic measurement should be used as an auxiliary tool. If the calcaneus tends to change position, it would be interesting to understand this process, which could eventually lead to improvement in the treatment of Haglund's deformity. [ABSTRACT FROM AUTHOR]