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

动态足部骨骼运动：足部类型和重建手术的评估

• 批准号: 8400401
• 负责人: William R. Ledoux
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-01 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8400401
• 关键词: Address; Affect; Age; Agreement; American; Arthritis; Calibration; Censuses; Clinical; Computer software; Computers; Control Groups; Custom; Data; Data Collection; Deformity; Descriptor; Devices; Diabetes Mellitus; Equilibrium; Etiology; Evaluation; Flatfoot; Fluoroscope; Fluoroscopy; General Population; Goals; Gold; Grouping; Height; High Prevalence; Imaging Techniques; Immobilization; Joints; Laboratories; Magnetic Resonance Imaging; Measurement; Measures; Medial; Medical Imaging; Medical pins; Metatarsal bone structure; Methods; Morphologic artifacts; Motion; Muscle; Nature; Older Population; Operative Surgical Procedures; Osteotomy; Pain; Patients; Population; Positioning Attribute; Prevalence; Procedures; Process; Reconstructive Surgical Procedures; Research; Scanning; Shapes; Structure; Study Subject; Subgroup; Surgeon; System; Talipes cavus; Talus; Tantalum; Techniques; Technology; Time; Tissues; Variant; Veterans; Weight-Bearing state; Work; base; bone; calcaneum; clinical care; clinically significant; flexibility; foot; foot bone; improved; in vivo; interest; kinematics; medical attention; nervous system disorder; novel; orthotics; patient population; pressure; public health relevance; soft tissue; tomography

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.

描述（由申请人提供）： 我们建议使用一种新颖的设备来跟踪足部的足部骨骼运动，这些足部是足部重建手术的候选手术对象。我们的目标是在手术前评估足部，以探索细微的功能差异，然后在术后一年再次评估，以确定足部是否已恢复正常。脚的尺寸和形状多种多样，足弓高度（低或高）通常是最常见的描述词。一些名义上被分类为低足弓或高足弓的脚实际上只是正常变化的一部分，本研究不感兴趣。相反，我们的目标是检查形状异常且适合手术的有症状（疼痛）的足部。扁平足（低足弓）是美国人最常见的足部疾病；治疗尚未标准化，可能涉及保守或手术选择。对于要执行哪些手术，外科医生之间几乎没有达成一致，但一个重要的考虑因素是后足外翻的存在。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，但如果存在后足外翻，则需要进行跟骨截骨术。高弓足在美国也很常见，在寻求手术治疗的患者中，有一个关键的分隔符将高弓足患者分为两个亚组：这些脚要么是灵活的，前脚驱动的，第一跖骨跖骨弯曲，后脚内翻可矫正，要么是固定的，有僵硬的畸形。前者通常可以通过软组织手术矫正，而后者则需要对第一跖骨和/或跟骨进行截骨术。所有这些情况下的一般概念是恢复通过脚到地面的负载路径。研究足部骨骼运动和足底压力是评估这一点的直接方法，无论是在术前的足型组中还是在术后与中性对齐的受试者进行比较。虽然足底压力测量技术已经很成熟，但量化体内足部骨骼运动却是一项艰巨的任务。尽管近几十年来运动捕捉和医学成像取得了巨大进步，但这些技术应用于足部时仍然充满问题。例如，动作捕捉需要在同一块骨头上有多个标记，由于脚部有许多小且形状复杂的骨头，因此需要将骨头分组在一起。该技术还存在软组织运动伪影的问题。其他方法，例如计算机断层扫描 (CT) 或磁共振成像 (MRI)，扫描时间较长，无法进行动态数据收集。直到最近，运动分析的黄金标准，包括通过骨针安装的标记和钽珠的动态放射立体分析，都是高度侵入性的。最近，双平面荧光检查已成为传统逆反射系统或非传统但高侵入性系统的替代品。然而，脚部给这项技术带来了一些独特的挑战，主要是由于脚骨较小且重叠的性质。我们的团队开发了一种双平面荧光镜系统，专为解决足部的独特问题而定制。本研究的目的是使用我们的双平面荧光镜来量化扁平足和高弓足受试者手术前和术后的足骨运动。我们将把这些脚与一组中立对齐的受试者进行比较和对比，看看手术前和术后的脚有何不同。我们的具体目标是： [1] 完善我们现有的双平面透视系统。到 减少处理时间，我们将从基于中央处理单元（CPU）的软件结构转向基于图形处理单元（GPU）的软件结构。我们还将通过增强的三维（3D）定位器和畸变校正框架来改进我们的校准； [2] 比较高弓足、扁平足和中性排列受试者的足骨运动和足底压力。术前，我们将研究四组患者：1）不伴有后足外翻的扁平足，2）伴有后足外翻的扁平足，3）柔性高弓足和4）固定高弓足。我们将在术后一年研究相同的四组，以及中性对齐患者的对照组。我们将比较脚型内、脚型之间和手术前/术后的患者。所有组都将与中立对齐的对照组进行比较。 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地量化足部骨骼运动，研究重建手术对两种常见病症（有症状的扁平足和高弓足）的影响。受试者将在手术前和术后接受检查，并与中性受试者进行比较。最近的研究表明，退伍军人的足部疾病患病率明显更高，包括平足和关节炎， 比非退伍军人。 2010年（www.census.gov），美国有3.08亿人，其中2180万退伍军人，其中900万年龄在65岁或以上。从人口统计学角度来看，大多数问题在老年人口中更为普遍。老年人群中糖尿病的患病率也较高。因此，退伍军人，特别是老年退伍军人，可能会患有扁平足、关节炎或糖尿病相关组织变化等饮食问题，其患病率高于一般人群，因此，他们将从我们小组提议的研究中受益。