Subtalar osteoarthritis

NewsBot · Apr 1, 2018

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Post-traumatic subtalar osteoarthritis: which grading system should we use?
de Muinck Keizer RJ et al
Int Orthop. 2016 Sep;40(9):1981-5

PURPOSE:
To assess and compare post-traumatic osteoarthritis following intra-articular calcaneal fractures, one must have a reliable grading system that consistently grades the post-traumatic changes of the joint. A reliable grading system aids in the communication between treating physicians and improves the interpretation of research. To date, there is no consensus on what grading system to use in the evaluation of post-traumatic subtalar osteoarthritis. The objective of this study was to determine and compare the inter- and intra-rater reliability of two grading systems for post-traumatic subtalar osteoarthritis.

METHODS:
Four observers evaluated 50 calcaneal fractures at least one year after trauma on conventional oblique lateral, internally and externally rotated views, and graded post-traumatic subtalar osteoarthritis using the Kellgren and Lawrence Grading Scale (KLGS) and the Paley Grading System (PGS). Inter- and intra-rater reliability were calculated and compared.

RESULTS:
The inter-rater reliability showed an intra-class correlation (ICC) of 0.54 (95 % CI 0.40-0.67) for the KLGS and an ICC of 0.41 (95 % CI 0.26 - 0.57) for the PGS. This difference was not statistically significant. The intra-rater reliability showed a mean weighted kappa of 0.62 for both the KLGS and the PGS.

CONCLUSION:
There is no statistically significant difference in reliability between the Kellgren and Lawrence Grading System (KLGS) and the Paley Grading System (PGS). The PGS allows for an easy two-step approach making it easy for everyday clinical purposes. For research purposes however, the more detailed and widely used KLGS seems preferable.
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NewsBot · Dec 29, 2019

Radiographic assessment of the subtalar joint: An evaluation of the Kellgren-Lawrence scale and proposal of a novel scale.
Vier D et al
Clin Imaging. 2019 Dec 5;60(1):62-66

OBJECTIVE:
To evaluate the reliability of grading subtalar (ST) arthrosis on lateral weightbearing radiographs in a heterogenous patient population using the Kellgren-Lawrence (KL) scale, correlate these findings to advanced imaging (CT and/or MRI), and to validate a novel scale.

MATERIALS AND METHODS:
A random collection of 40 lateral weightbearing radiographs presenting to a foot and ankle clinic were reviewed by nine multi-disciplinary independent reviewers. Interobserver reliability was assessed for KL scores. A musculoskeletal radiologist graded available advanced imaging on all 40 radiographs and the advanced imaging scores were correlated to the radiographic scores. A novel scoring system was created and tested for interobserver reliability.

RESULTS:
There was overall fair reliability amongst reviewers with the traditional KL score, kappa = 0.26. The best agreement was seen amongst those deemed to have a grade 0, with only moderate agreement (k = 0.50). There was only fair interobserver reliability with severe, Grade 4 scores (k = 0.28). Radiographic scores did have moderate correlation with advanced imaging (r = 0.56). A new, simple grading system was proposed and its interobserver reliability was improved substantially (kappa =0.68).

CONCLUSIONS:
The KL scoring system is not applicable to the subtalar joint. The new NSS grading system has improved reliability. Radiographs only had moderate correlation to advanced imaging. Further studies are warranted to correlate clinically.
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NewsBot · Mar 8, 2022

Extracorporeal Pulse Activation Therapy and Amniotic Extracellular Matrix Injection for post-traumatic subtalar joint osteoarthritis: A case study
Ziad Labbad, MD, DPM, CPed et al
Journal of the International Foot & Ankle Foundation Vol. 1 No. 3 (2022): March 2022

This case study evaluates the use of Extracorporeal Pulse Activation Therapy (EPAT) and Amniotic Extracellular Matrix Injection (AEMI) in a patient suffering unilateral post-traumatic subtalar joint (STJ) osteoarthritis. Following an injury he was not able to work or exercise secondary to subtalar joint pain. He had failed treatment with bracing, physical therapy, and PRP injections and was not interested in surgery. Following serial EPAT and AEMI the patient had a decrease in pain score (from 5/10 at rest, to 2/10 with activity and 0/10 at rest) and was able to return to work and activities. In conclusion, EPAT and AEMI are effective treatments for STJ arthritis, present a viable alternative to surgery, and should be explored for use in other degenerative conditions of the foot and ankle
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NewsBot · Sep 5, 2023

Foot biomechanics in patients with advanced subtalar- and Chopart joint osteoarthritis and poorly responding to conservative treatment
Kevin Deschamps, Karel Mercken, Pieter Verschuren, Maarten Eerdekens, and 3 more
This is a preprint

Background
A comprehensive insight into the effects of subtalar- and Chopart joint osteoarthritis on lower limb’s biomechanical characteristics during walking is lacking. Our goal was to assess joint kinematics and kinetics and compensatory mechanisms in patients with subtalar and Chopart joint osteoarthritis.

Methods
Patients with symptomatic and radiographically confirmed osteoarthritis of the subtalar and Chopart joint (n = 10) and an asymptomatic control group (n = 10) were compared. Foot joint kinematics and kinetics during the stance phase of walking were quantified using a four segment foot model.

Results
During pre-swing phase, the Ankle range of motion in the sagittal plane of the patient group decreased significantly (P = 0.001), whereas the Lisfranc joint range of motion in the sagittal plane was greater in the pre-swing phase (P = 0.003). The Chopart joint showed lower transverse plane range of motion in the patient group during the loading response and pre-swing phase (P < 0.001 resp. P = 0.002). The patient group showed a lower Ankle peak plantarflexion moment (P = 0.004), peak plantarflexion velocity (P < 0.001) and peak power generation in the sagittal plane (P < 0.001), and a lower Chopart joint peak adduction and abduction velocity (P < 0.001 resp. P < 0.001) and peak power absorption (P < 0.001).

Conclusions
These findings suggest that patients with subtalar and Chopart joint osteoarthritis adopt a cautious walking strategy potentially dictated by pain, muscle weakness, kinesiophobia and stiffness. Since this poorly responding population faces surgical intervention on the short term, we recommend careful follow-up after fusion surgery since biomechanical outcome measures associated to this post-surgical stage is lacking.
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NewsBot · Feb 26, 2024

Foot biomechanics in patients with advanced subtalar- and mid-tarsal joint osteoarthritis and poorly responding to conservative treatment
Kevin Deschamps, Karel Mercken, Pieter Verschuren, Maarten Eerdekens, Eline Vanstraelen, Sander Wuite & Giovanni A. Matricali
Journal of Foot and Ankle Research volume 16, Article number: 85 (2023)

Background
A comprehensive insight into the effects of subtalar- and mid-tarsal joint osteoarthritis on lower limb’s biomechanical characteristics during walking is lacking. Our goal was to assess joint kinematics and kinetics and compensatory mechanisms in patients with subtalar and mid-tarsal joint osteoarthritis.

Methods
Patients with symptomatic and radiographically confirmed osteoarthritis of the subtalar and mid-tarsal (n = 10) and an asymptomatic control group (n = 10) were compared. Foot joint kinematics and kinetics during the stance phase of walking were quantified using a four-segment foot model.

Results
During pre-swing phase, the tibio-talar range of motion in the sagittal plane of the patient group decreased significantly (P = 0.001), whereas the tarso-metatarsal joint range of motion in the sagittal plane was greater in the pre-swing phase (P = 0.003). The mid-tarsal joint showed lower transverse plane range of motion in the patient group during the loading response and pre-swing phase (P < 0.001 resp. P = 0.002). The patient group showed a lower Tibio-talar joint peak plantarflexion moment (P = 0.004), peak plantarflexion velocity (P < 0.001) and peak power generation in the sagittal plane (P < 0.001), and a lower mid-tarsal joint peak adduction and abduction velocity (P < 0.001 resp. P < 0.001) and peak power absorption (P < 0.001).

Conclusions
These findings suggest that patients with subtalar and mid-tarsal joint osteoarthritis adopt a cautious walking strategy potentially dictated by pain, muscle weakness, kinesiophobia and stiffness. Since this poorly responding population faces surgical intervention on the short term, we recommend careful follow-up after fusion surgery since biomechanical outcome measures associated to this post-surgical stage is lacking.
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