|Year : 2017 | Volume
| Issue : 3 | Page : 144-147
Standardized radiological values of foot among Saudi population
Nader Alkenani1, Mohammed Alaqil2, Ammar Murshid2, Mohammed Alharbi2, Odai Albahli2, Suliman Alghnam3
1 Department of Surgery, Division of Orthopaedic Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
2 Department of Clinical Affairs, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3 Research Unit, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
|Date of Web Publication||4-Oct-2017|
King Abdulaziz Medical City, Riyadh
Background: Radiographic measurements are crucial in determining surgical procedures and preoperative workups. In Saudi Arabia, European-American prostheses are imported. This eventually may not match the population's needs.
Objectives: The objective of the study is to examine radiographic foot measurements in Saudi adult population including central tendency measurements and age-group categorization.
Methodology: In this descriptive retrospective cross-sectional study conducted in Riyadh at King Abdulaziz Medical City, radiological records for 99 individuals including 38 males (38%) between 2010 and 2014 were reviewed. Foot angular measurements of total 1212 measurements were performed on 140 feet for both anterior-posterior (AP) and lateral (LAT) views. On the AP-view including HV, IM1-2, IM1-5, TN, T.C, and AP-Meary angles, while on the LAT-view including LAT-Meary, Hibb, Djian, and confidence interval (CI) angles were measured. All of the patients, on the same hand, are skeletally mature, with a clear history from foot operations, fractures, deformities, traumatic shocks, and degenerative and systemic diseases. Measurements were further categorized by the age groups (18–40 and 41–74) regardless gender.
Results: Angular varieties did not differ significantly between the two age groups, but IM1-5 and CI angles exhibited strong significance (P = 0.01 and 0.049, respectively). There was also no significant difference in angles between right and left feet.
Discussion: Our findings demonstrate that angular measurements of our population differ than other populations. Gender and age group within an extended range might fill the void of the previous studies. The measurements of central tendency for all angles differ than other studies because both populations differ than the other. Although that other studies have some sort of thoroughness, the ethnicity criteria were not mindfully taken. Our study conducted the convenience sampling taking into consideration the fact that ethnicity and other inclusion criteria are crucial.
Conclusion: The standardized angular measurements of foot among Saudi adult differ from other populations. Therefore, local prosthetic designs of foot should be manufactured accordingly.
Keywords: 1212, foot, measurements, radiological
|How to cite this article:|
Alkenani N, Alaqil M, Murshid A, Alharbi M, Albahli O, Alghnam S. Standardized radiological values of foot among Saudi population. Saudi J Sports Med 2017;17:144-7
|How to cite this URL:|
Alkenani N, Alaqil M, Murshid A, Alharbi M, Albahli O, Alghnam S. Standardized radiological values of foot among Saudi population. Saudi J Sports Med [serial online] 2017 [cited 2018 Jul 22];17:144-7. Available from: http://www.sjosm.org/text.asp?2017/17/3/144/215918
| Introduction|| |
Radiographic measurements are significant for assisting the physician in determining surgical procedures and preoperative workups such as pes cavus, pes planus, and hallux valgus.
Besides, norms of radiographic measurements of feet in Saudi Arabia are set according to European-American styles; hence, a large number of prosthetic foot designs and sizes may not match the population's needs. Consequently, a standardized Saudi guideline for foot angular values based on computerized measurements is essential for clinical investigations.
The particular aim of this study is to examine the radiographic measurements of normal foot in Saudi adult population. This study will help orthopedic surgeons in Saudi Arabia to detect which surgical procedure can be done as well as helping them regarding their diagnostic workups.
- To estimate the average normal foot based on computerized angular measurements among Saudi adult population
- To calculate the angular varieties among male and female by sorting the measurements into two different age groups among Saudi adult population [Figure 1], [Figure 2], [Figure 3], [Figure 4].
|Figure 1: Maximum, minimum, median, and standard deviation of 139 feet for anterior-posterior aspect for both genders|
Click here to view
|Figure 2: Maximum, minimum, median, mean, and standard deviation of 92 feet for lateral aspect for both genders|
Click here to view
|Figure 3: Arithmetic mean of the angular measurements for anterior-posterior view of two different age groups (G1: 18–40 and G2: 41–74) along with the P value. The standard deviation of G1. The standard deviation of G2|
Click here to view
|Figure 4: Arithmetic mean of the angular measurements for anterior-posterior view of two different age groups (G1: 18–40 and G2: 41–74) along with the P value. The standard deviation of G1. The standard deviation of G2|
Click here to view
| Methodology|| |
This descriptive cross-sectional study was conducted in the orthopedic and radiology departments at Riyadh National Guard Hospital. A total sample size of 99 average patients (38 males and 61 females) with age ranging from 18 to 74 years of total 140 feet (140 for anterior-posterior (AP) including 92 lateral (LAT). All of the patients are skeletally mature, with a clear history from foot operations, fractures, deformities, traumatic shocks, and degenerative and systemic diseases. The four coinvestigators started their data collection by targeting the records from the departments by sorting all the registries of patients whom are presented to the surgeon who are included in this study between 2010 and 2014. The angular measurements were ten values, selected mindfully for both AP and LAT aspects. On the AP view, six angles were collectively measured: Hallux Valgus, IM1-2, IM1-5, Talocalcaneal (Kite), Talonavicular Coverage, and AP Meary-Tomeno's angles. On the LAT view, however, four angles were calculated: Djian-Annonier's, Calcaneal Inclination (calcaneal pitch), LAT Meary-Tomeno's, and Hibb's angles. All the 1212 measurements, on the same hand, were digitally stored on a compact disk and were obtained using a workstation (centricity radiology information system) and QuadraMed software.
Terms and descriptions of anterior-posterior and lateral angular measurements
| Results|| |
Angular varieties did not differ significantly between the two age groups, but IM1 5 and CI angles exhibited strong significance (P = 0.01 and 0.049, respectively). There was also no significant difference in angles between right and left feet.
| Discussion|| |
Our findings demonstrate that angular measurements of our population differ than other populations. Gender and age group within an extended range might fill the void of the previous studies. The measurements of central tendency for all angles differ than other studies because both populations differ than the other. Although that other studies have some sort of thoroughness, the ethnicity criteria were not mindfully taken., Our study conducted the convenience sampling taking into consideration the fact that ethnicity and other inclusion criteria are crucial although that it might have some limitations.,,,,
This study is limited to the sample size as it is in a convenient sampling technique that is conducted on one tertiary hospital. In addition, despite close monitoring of measurement techniques and the use of computer-aided design soft-wares, human errors may be encountered. Our research team is looking forward to make our study much more generalizable for different tertiary referral centers around the country.
| Conclusion|| |
According to the results and its analysis, the study has concluded that:
- The standardized angular measurements of foot among Saudi adult population comparing to other populations are not alike; hence, prosthetic designs of foot should be made according to the society ,,,,
- There is no difference between the right and left feet between the two genders according to our study
- Angular varieties did not differ significantly between the two age groups, but IM1-5 and confidence interval angles exhibited strong significance (P = 0.01 and 0.049, respectively).,,,
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Roddy E, Zhang W, Doherty M. Prevalence and associations of hallux valgus in a primary care population. J Bone Joint Surg 2008;59:857-62.
Karasick D, Wapner KL. Hallux valgus deformity: Preoperative radiologic assessment. AJR Am J Roentgenol 1990;155:119-23.
Steel MW 3rd
, Johnson KA, DeWitz MA, Ilstrup DM. Radiographic measurements of the normal adult foot. Foot Ankle 1980;1:151-8.
Thomas JL, Kunkel MW, Lopez R, Sparks D. Radiographic values of the adult foot in a standardized population. J Foot Ankle Surg 2006;45:3-12.
Fuson SM, Smith SD. Angular relationships of the metatarsal, talus and calcaneus: A radiographic analysis. J Am Podiatry Assoc 1978;68:463-6.
Bryant A, Tinley P, Singer K. A comparison of radiographic measurements in normal, hallux valgus, and hallux limitus feet. J Foot Ankle Surg 2000;39:39-43.
Haas M. Radiographic and biomechanical considerations of bunion surgery. In: Gerbert J, Sokoloff TH, editors. Textbook of Bunion Surgery. Mount Kisco, NY: Futura; 1981. p. 23-61.
Laporta G, Melillo T, Olinsky D. X-ray evaluation of hallux abducto valgus deformity. J Am Podiatry Assoc 1974;64:544-66.
Gamble FO, Yale I. Clinical Foot Roentgenology. New York: Krieger Publishing Co.; 1975. p. 186-208.
Hardy RH, Clapham JC. Observations on hallux valgus; based on a controlled series. J Bone Joint Surg Br 1951;33-B: 376-91.
Fallat LM, Buckholz J. An analysis of the tailor's bunion by radiographic and anatomical display. J Am Podiatry Assoc 1980;70:597-603.
Sorto LA Jr., Balding MG, Weil LS, Smith SD. Hallux abductus interphalangeus: Etiology, x-ray evaluation and treatment. J Am Podiatry Assoc 1976;66:384-96.
Kimartin RL, Barrington RL, Wallace WW. The x-ray measurement of hallux valgus: An inter- and intra-observer error study. Foot 1992;2:7-11.
Brage ME, Bennett CR, Whitehurst JB, Getty PJ, Toledano A. Observer reliability in ankle radiographic measurements. Foot Ankle Int 1997;18:324-9.
Palladino SJ, Towfigh A. Intra-evaluator variability in the measurement of proximal articular set angle. J Foot Surg 1992;31:120-3.
Schneider W, Csepan R, Knahr K. Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery. J Bone Joint Surg Am 2003;85-A: 494-9.
Kaschak T, Laine W. Surgical Radiology, Clinics in Podiatric Medicine and Surgery. Vol. 5. Philadelphia, PA: WB Saunders; 1988. p. 797-829.
Baron RL, Gianfortune PJ, Evans DP, Strugielski CF. Imaging/radiology. In: Benard MA, Kravitz SR, editors. Review Text in Podiatric Orthopedics and Primary Podiatric Medicine. Baltimore, MD: Data Trace Publishing; 1997.
Engel E, Erlick N, Krems I. A simplified metatarsus adductus angle. J Am Podiatry Assoc 1983;73:620-8.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]