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Progressive Collapsing Foot Deformity (PCFD) is a complex, multiplanar condition characterized by hindfoot valgus, peritalar subluxation, midfoot abduction, and collapse of the medial arch, which may progress to rigid deformity with pain and functional impairment. In advanced stages, subtalar arthrodesis is a well-established surgical option to restore hindfoot alignment and stability.
Subtalar Arthrodesis with Mini/Medial Bone Block (SAMBB) is an evolution of the Grice-Green technique, using an autologous bone graft to achieve stable correction of talocalcaneal alignment and improve joint congruency, with favorable clinical and radiographic outcomes.
This study aims to evaluate the three-dimensional corrective effect of SAMBB using weight-bearing CT (WBCT), focusing on hindfoot alignment and talocalcaneal and talonavicular relationships.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| enrolled patients | Experimental | Patients of both sexes, aged between 18 and 80 years, affected by grade A2 Progressive Collapsing Foot Deformity (PCFD). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Weight-Bearing CT scan | Diagnostic Test | Weight-Bearing CT scan after surgery |
|
| Measure | Description | Time Frame |
|---|---|---|
| Foot and Ankle Offset | A three-dimensional parameter derived from weight-bearing CT (WBCT) acquisitions that allows objective quantification of the global alignment of the foot-ankle unit. It measures the spatial relationship between the functional tripod of the foot (first metatarsal, fifth metatarsal, and calcaneus) and the geometric center of the tibiotalar joint, effectively representing a synthetic index of the morpho-functional balance of the hindfoot-midfoot complex. | At baseline; After 6 months post op |
| Measure | Description | Time Frame |
|---|---|---|
| Talo-navicular congruency angle | A three-dimensional parameter that assesses talonavicular joint alignment and quantifies the degree of midfoot abduction (PCFD class B). It reflects the extent to which the talar head is "uncovered" relative to the navicular, indicating external rotation and lateral translation of the midfoot typical of PCFD. An increased TNCA corresponds to greater talonavicular incongruity and represents a three-dimensional marker of the transverse component of the deformity. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Massimiliano Mosca, MD | Contact | 3355881233 | +39 | massimiliano.mosca@ior.it |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Istituto Ortopedico Rizzoli | Bologna | 40136 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36673035 | Result | Polichetti C, Borruto MI, Lauriero F, Caravelli S, Mosca M, Maccauro G, Greco T, Perisano C. Adult Acquired Flatfoot Deformity: A Narrative Review about Imaging Findings. Diagnostics (Basel). 2023 Jan 7;13(2):225. doi: 10.3390/diagnostics13020225. | |
| 32856474 | Result | Myerson MS, Thordarson DB, Johnson JE, Hintermann B, Sangeorzan BJ, Deland JT, Schon LC, Ellis SJ, de Cesar Netto C. Classification and Nomenclature: Progressive Collapsing Foot Deformity. Foot Ankle Int. 2020 Oct;41(10):1271-1276. doi: 10.1177/1071100720950722. Epub 2020 Aug 28. |
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| At baseline; After 6 months post op |
| Middle facet Incongruency angle | The degree of incongruity between the talus and calcaneus at the level of the middle facet of the subtalar joint. It is a direct indicator of peritalar subluxation, one of the key features of PCFD (class A/D). Increased values suggest instability of the subtalar complex, loss of joint congruency, and three-dimensional hindfoot malalignment, with impairment of the subtalar joint's rotational function and load distribution. | At baseline; After 6 months post op |
| Forefoot arch angle | A three-dimensional parameter that evaluates the stability and morphology of the medial and transverse arches at the level of the midfoot (PCFD class C). It reflects the behavior of the medial cuneiform and the first ray under load, describing the ability of the medial column to maintain adequate structural support. | At baseline; After 6 months post op |
| Hindfoot moment arm | A three-dimensional measure of calcaneal alignment relative to the tibial axis, representing a direct index of hindfoot valgus. It quantifies the lateral displacement of the calcaneus under the tibial load, objectively describing the hindfoot deviation that characterizes the coronal component of PCFD (class A). | At baseline; After 6 months post op |
| Calcaneofibular distance and subtalar impigemen | It evaluates the three-dimensional distance between the lateral surface of the calcaneus and the medial aspect of the fibula, serving as an indirect indicator of subfibular impingement (SFI). A reduction in this distance suggests mechanical conflict due to the combination of calcaneal valgus, lateral displacement of the hindfoot, and instability of the subtalar ligamentous complex. SFI is typical of advanced, rigid PCFD and is associated with progressive lateral load alteration (PCFD class D). | At baseline; After 6 months post op |
| 39160476 | Result | Cai Y, Zhao Z, Huang J, Yu Z, Jiang M, Kang S, Yuan X, Liu Y, Wu X, Ouyang J, Li W, Qian L. Morphological changes in flatfoot: a 3D analysis using weight-bearing CT scans. BMC Med Imaging. 2024 Aug 19;24(1):219. doi: 10.1186/s12880-024-01396-0. |
| 31879733 | Result | Mosca M, Caravelli S, Vannini F, Pungetti C, Catanese G, Massimi S, Fuiano M, Faldini C, Giannini S. Mini Bone Block Distraction Subtalar Arthrodesis (SAMBB) in the Management of Acquired Adult Flatfoot with Subtalar Arthritis: A Modification to the Grice-Green Procedure. Joints. 2019 Dec 13;7(2):64-70. doi: 10.1055/s-0039-3400452. eCollection 2019 Jun. |
| 32779535 | Result | Mosca M, Caravelli S, Vocale E, Massimi S, Fuiano M, Grassi A, Ceccarelli F, Zaffagnini S. Outcome After Modified Grice-Green Procedure (SAMBB) for Arthritic Acquired Adult Flatfoot. Foot Ankle Int. 2020 Nov;41(11):1404-1410. doi: 10.1177/1071100720938665. Epub 2020 Aug 11. |
| 28926392 | Result | de Cesar Netto C, Schon LC, Thawait GK, da Fonseca LF, Chinanuvathana A, Zbijewski WB, Siewerdsen JH, Demehri S. Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography. J Bone Joint Surg Am. 2017 Sep 20;99(18):e98. doi: 10.2106/JBJS.16.01366. |
| 38398256 | Result | Pasapula CS, Choudkhuri MR, Monzo ERG, Dhukaram V, Shariff S, Pasterse V, Richie D, Kobezda T, Solomou G, Cutts S. Review of Classification Systems for Adult Acquired Flatfoot Deformity/Progressive Collapsing Foot Deformity and the Novel Development of the Triple Classification Delinking Instability/Deformity/Reactivity and Foot Type. J Clin Med. 2024 Feb 6;13(4):942. doi: 10.3390/jcm13040942. |
| ID | Term |
|---|---|
| D005413 | Flatfoot |
| ID | Term |
|---|---|
| D000070558 | Talipes |
| D005531 | Foot Deformities, Acquired |
| D005530 | Foot Deformities |
| D009140 | Musculoskeletal Diseases |
| D005532 | Foot Deformities, Congenital |
| D038061 | Lower Extremity Deformities, Congenital |
| D017880 | Limb Deformities, Congenital |
| D009139 | Musculoskeletal Abnormalities |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
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