Dynamic Foot Bone Motion: Evaluation of Foot Type and Reconstructive Procedures

描述（由申请人提供）： 我们建议使用一种新的设备来跟踪足部骨骼运动，这些足部骨骼运动是足部重建手术的外科候选者。我们的目标是评估术前足部，以探索细微的功能差异，然后再次手术后1年，以确定足部是否已恢复正常。脚有各种各样的大小和形状，通常足弓高度（低或高）是最常见的描述。一些名义上被归类为低拱或高拱的脚实际上只是正常变化的一部分，并不是本研究的兴趣。Rathe，我们的目标是检查有症状（疼痛）的脚，有异常的形状和手术的候选人。扁平足（低足弓）是美国人最常见的足部疾病;治疗方法不规范，可能涉及保守或手术选择。外科医生对该采用何种手术方式意见不一，但一个重要的考虑因素是是否存在后足外翻。如果没有这种畸形，疼痛的扁平足通常可以通过内侧柱手术来矫正，但是如果存在后足外翻，则需要跟骨截骨。高弓足（高足弓）在美国也很普遍，在寻求手术治疗的患者中，有一个关键的分离器将高弓足患者分为两个亚组;这些足要么是灵活的，前足驱动，足底弯曲的第一跖骨和可矫正的后足内翻，要么是固定的，刚性畸形。前者通常可通过软组织手术进行矫正，而后者则需要对第一跖骨和/或跟骨进行截骨术。在所有这些情况下的一般概念是恢复通过脚到地面的载荷路径。研究足部骨骼运动和足底压力是评估这一点的直接手段，无论是在足型组手术前，并与中立对齐的主题手术后。虽然足底压力测量技术已经很好地建立，但是量化体内的脚骨运动是一项重要的任务。尽管近几十年来在动作捕捉和医学成像方面取得了长足的进步，但这些技术在应用于足部时仍然充满了问题。例如，运动捕捉需要在同一块骨头上有多个标记，这是由于脚部有许多小而复杂的骨头，因此需要将骨头分组在一起。该技术还遭受软组织运动伪影。其他方法，例如计算机断层扫描（CT）或磁共振成像（MRI）具有长的扫描时间，这妨碍了动态数据收集。直到最近，运动分析的黄金标准，包括通过骨钉安装的标记和钽珠的动态放射立体测量分析，都是高度侵入性的。近年来，双平面透视已成为传统回射系统或非传统但高度侵入性系统的替代方案。然而，足部对这项技术提出了一些独特的挑战，主要是由于足部骨骼的小而重叠的性质。我们的团队开发了一种双平面荧光镜系统，专门针对足部的独特问题。本研究的目的是使用我们的双平面荧光镜来量化手术前和手术后的平足和高弓足受试者的足部骨骼运动。我们将把这些脚与一组中性排列的受试者进行比较和对比，看看手术前后的脚有什么不同。我们的具体目标是：[1]完善我们现有的双平面透视系统。到 为了减少处理时间，我们将从基于中央处理器（CPU）的软件结构转向基于图形处理器（GPU）的软件结构。我们还将使用增强的三维（3D）定位器和失真校正帧来改进我们的校准; [2]比较高弓足、平坦足和中性对齐受试者的足部骨骼运动和足底压力。术前，我们将研究四组患者：1）不伴后足外翻的扁平足，2）伴后足外翻的扁平足，3）柔性弓状足和4）固定弓状足。我们将研究相同的四组术后1年的患者，以及一个中立对线患者的对照组。我们将比较足型内、足型与手术前/手术后的患者。将所有组与中性对齐对照品进行比较。 公共卫生相关性： 本研究将通过使用我们小组开发的定制系统来非常准确和精确地量化足部骨骼运动，调查重建手术对两种常见疾病（症状性扁平足和高足弓足）的影响。将在术前和术后对受试者进行检查，并与中立受试者进行比较。最近的研究表明，退伍军人有一个显着更高的足部疾病的患病率，包括扁平足和关节炎， 非退伍军人。在2010年（www.census.gov），有3.08亿美国人，其中2180万是退伍军人，包括900万谁是65岁或以上。从人口统计学的角度来看，大多数肥胖问题在老年人中更为普遍。糖尿病的患病率在老年人中也较高。因此，退伍军人，特别是老年退伍军人，很可能患有食物问题，如扁平足，关节炎或糖尿病相关的组织变化，患病率高于普通人群，因此，他们将从我们小组提出的研究中受益。

DESCRIPTION (provided by applicant): We are proposing to use a novel device to track foot bone motion in feet that are surgical candidates for foot reconstructive procedures. We aim to evaluate feet pre-surgery to explore subtle functional differences, and then again 1 year post-surgery to determine if the feet have been restored to normal. Feet come in a wide range of sizes and shapes, and often arch height (low or high) is the most common descriptor. Some feet which are nominally classified as low or high arched are actually just part of normal variation and are not of interest to this study. Rathe, we aim to examine symptomatic (painful) feet that have aberrant shapes and are candidates for surgery. Pes planus (low arch) is the most common foot condition in Americans; treatment is not well-standardized and may involve conservative or surgical options. There is little agreement among surgeons as to which procedures to perform, but an important consideration is the presence of hindfoot valgus. Without this deformity, painful flatfeet can often be corrected with medial column procedures, but if hindfoot valgus is present, then a calcaneal osteotomy is required. Pes cavus (high arch) is also prevalent in the US and among patients seeking surgical remedy, there is a key separator that divides pes cavus patients into two subgroups; these feet are either flexible and forefoot driven, with a plantar flexed first metatarsal and a correctible hindfoot varus, or they are fixed, with a rigid deformity. The former is often correctible with sof tissue procedures, while the latter requires an osteotomy of the first metatarsal and/or the calcaneus. The general concept in all these cases is to restore the load path through the foot to the ground. Studying foot bone motion and plantar pressure is a direct means of evaluating this, both within foot type group pre-surgically and compared to neutrally aligned subjects post-surgically. While plantar pressure measurement technologies are well established, quantifying foot bone motion in vivo is a non-trivial task. Despite great strides in recent decades in motion capture and medical imaging, these techniques remain fraught with problems when applied to the foot. For instance, motion capture requires multiple markers on the same bone, which due to the many small and intricately shaped bones in the foot necessitates grouping bones together. The technique also suffers from soft tissue motion artifact. Other methods, such as computer tomography (CT) or magnetic resonance imaging (MRI) have long scan times that preclude dynamic data collection. Until recently, the gold standards for motion analysis, including markers mounted via bone pins and dynamic radiostereometric analysis of tantalum beads, were highly invasive. Recently, biplane fluoroscopy has become an alternative to traditional retro-reflective systems or to the non-traditional but highly invasive systems. However, the foot provides some unique challenges to this technique, mostly due to the small, overlapping nature of the foot bones. Our group has developed a biplane fluoroscope system that is tailored to address the unique issues of the foot. The purpose of this study is to use our biplane fluoroscope to quantify foot bone motion of pes planus and pes cavus subjects pre- and post-surgery. We will compare and contrast these feet to a group of neutrally- aligned subjects to see how the pre- and post-surgical feet differ. Our Specific Aims are: [1] Refine our existing biplane fluoroscopy system. To decrease processing time, we will move from a central processing unit (CPU)-based to a graphics processing unit (GPU)-based software structure. We will also improve our calibration with enhanced three-dimensional (3D) localizer and distortion correction frames; [2] Compare the foot bone motion and plantar pressure of pes cavus, pes planus, and neutrally aligned subjects. Pre- surgically, we will study four groups of patients: 1) pes planus without hindfoot valgus, 2) pes planus with hindfoot valgus, 3) flexible pes cavus and 4) fixed pes cavus. We will study the same four groups 1-year post- surgery, as well as a control group of neutrally aligned patients. We will compare patients within foot type, between foot type and pre-/post-surgically. All groups will be compared to the neutrally aligned controls. PUBLIC HEALTH RELEVANCE: This study will investigate the effect of reconstructive surgery on two common conditions (symptomatic flat and high arched feet) by using a custom system our group has developed to very accurately and precisely quantify foot bone motion. Subjects will be examined pre- and post-surgery, and will be compared to neutral subjects. It has recently been shown that Veterans have a significantly higher prevalence of foot maladies, including flatfoot and arthritis, than non-Veterans. In 2010 (www.census.gov), there were 308 milion Americans, of which 21.8 million were Veterans, including 9 million who were 65 or older. Demographicaly, most fot problems are more prevalent in older populations. The prevalence of diabetes is also higher in older populations. Therefore, Veterans, in particular older Veterans, are likely to suffer from foo problems such as pes planus, arthritis or diabetes related tissue changes, at a higher prevalence than the general population, and as such, they stand to benefit from the research that our group is proposing.