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的骨骼运动，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对足部进行评估，以探索细微的功能差异，然后在手术后1年再次评估足部是否恢复正常。脚的大小和形状多种多样，通常最常见的描述是足弓的高度(低或高)。有些脚名义上被归类为低拱形或高拱形，实际上只是正常变化的一部分，对这项研究不感兴趣。Rathe，我们的目标是检查有症状的(疼痛的)脚，这些脚的形状异常，适合做手术。扁平足(低弓)是美国人最常见的足部疾病；治疗没有很好的标准化，可能需要保守或手术治疗。外科医生对实施哪种手术几乎没有达成一致意见，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。Pes Cavus(高弓)在美国也很常见，在寻求手术治疗的患者中，有一个关键的分离器将Pes Cavus患者分为两个亚组；这两只脚要么是灵活的，要么是前脚驱动的，第一跖底屈曲，后足内翻可矫正，要么是固定的，带有僵硬的畸形。前者通常可以通过sof组织手术矫正，而后者则需要第一跖骨和/或跟骨的截骨术。在所有这些情况下，一般的概念是通过脚部将载荷路径恢复到地面。研究足部骨骼运动和足底压力是评估这一点的直接手段，无论是在手术前足型组中，还是在手术后与中性对齐的受试者中都是如此。虽然足底压力测量技术已经成熟，但在体内量化足部骨骼运动并不是一项微不足道的任务。尽管近几十年来在运动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问题。例如，运动捕捉需要同一骨骼上的多个标记，由于脚中有许多形状复杂的小骨骼，因此需要将骨骼分组在一起。该技术还受到软组织运动伪影的影响。其他方法，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，包括通过骨钉安装的标记和对钽珠的动态放射立体分析，都是高度侵入性的。近年来，双平面透视已成为传统逆向反射系统或非传统但高度侵入性系统的替代方案。然而，脚部给这项技术带来了一些独特的挑战，主要是因为脚部骨骼的小而重叠的性质。我们团队开发了一种双平面透视系统，专为解决脚部的独特问题而量身定做。本研究的目的是利用我们的双平面透视技术对平坦性和下腔静脉受试者手术前后的足部骨骼运动进行量化。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，看看手术前和手术后的脚有什么不同。我们的具体目标是：[1]改进我们现有的双平面透视系统。至 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。我们还将通过增强的三维(3D)定位仪和失真校正框架来改进我们的校准；[2]比较PES下腔、PES扁平和中性排列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)无后足外翻的平坦型PES，2)合并后足外翻的扁平型PES，3)软性PES和4)固定型PES。我们将在术后1年研究同样的四组患者，以及中性对齐患者的控制组。我们将比较足型、足型和手术前后的患者。所有组都将与中性对齐的对照组进行比较。 公共卫生相关性： 这项研究将使用我们团队开发的非常精确和精确地量化足部骨骼运动的定制系统来研究重建手术对两种常见情况(有症状的扁平足和高足弓足)的影响。受试者将在手术前和术后接受检查，并将其与中性受试者进行比较。最近有研究表明，退伍军人患足部疾病的比例要高得多，包括扁平足和关节炎， 而不是退伍军人。2010年，美国有3.08亿美国人，其中2180万是退伍军人，其中900万是65岁或以上的人。从人口统计学上看，大多数FOT问题在老年人群中更为普遍。糖尿病在老年人群中的患病率也更高。因此，退伍军人，特别是年长的退伍军人，很可能比普通人群更容易患上扁平苔藓、关节炎或糖尿病相关的组织变化等FOO问题，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.