CURRENT LINES AND ANGLES USED IN PAEDIATRIC FOOT RADIOGRAPH: A SCOPING REVIEW OF LITERATURE

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J. Doski

Department of Surgery, College of Medicine, University of Duhok, Iraq

Abstract

Objective: This article aimed to review the main currently described lines and angles and gather them in a single article and arrange them in a systematic way to facilitate the process of assessment of the pediatric foot for deformities.

Methods: The review was a scoping literature review. Electronic database websites such as PubMed, Europe PMC, Cochrane Library, and Google Scholar in addition to some books on anatomy and human movements biomechanics, diagnostic radiology, and orthopedics were searched for relevant articles for the topic of the present review. No statistical analysis was applied in this review.

Results: Data from thirty articles included in this review were arranged into different subheadings. In the anteroposterior view (AP), assessment of the hindfoot deviation was by the AP talo-calcaneal angle (Kite’s angle); the forefoot and midfoot for abduction and adduction alignment was by the AP talo-first metatarsal angle, the talo-second metatarsal angle, the calcaneo-second metatarsal angle, the calcaneofifth metatarsal angle; the forefoot and midfoot rotation was by observing the normal proximal convergence of the metatarsal bones axes. In the lateral view, assessment of the hindfoot sagittal plane alignment was by the lateral tibio-calcaneal angle; hindfoot varus or valgus deviation by the lateral talo-calcaneal angle; talus bone alignment by talar declination angle and the tibio-talar angle; calcaneal bone alignment by the calcaneal inclination angle and the tibio-calcaneal angle, the midfoot and forefoot sagittal plane alignment for the plantar arch by the lateral talo-first metatarsal -Meary’s- angle, the calcaneal inclination angle, and the lateral calcaneofirst metatarsal -Hibbs- angle; forefoot and midfoot rotational alignment by observing the overlap shadows of the metatarsals’ shafts and drawing their axes.

Conclusion: Drawing certain lines and angles with a systematic approach to assess different regions of the foot in the radiographic films of children can facilitate the process of assessment of the foot (as a whole) for deformities.

Keywords: Paediatric foot deformities, Radiography, Imaging, Lines, Angles

Introduction

Pediatric foot deformities are the deformities that could be found in the feet of newly born babies and children whether due to congenital or acquired causes. These deformities are diagnosed mainly clinically, but imaging studies are mainly used to assess association of bone deformities and may be required in certain conditions, either for confirmation of the clinical suspicion, measuring the degree of the malalignments (for grading and/or classification purposes), and/or follow-up of cases. Conventional radiography using plain X-ray is a useful imaging tool for the assessment of alignment for different regions of the foot. It is usually the first and the most common imaging study required. Additional imaging studies may be required but under the guidance of the plain X-ray film.^1,2 During the radiographic assessment of pediatric foot deformities, certain lines are drawn and certain angles are measured. Unfortunately, some articles and references describe the radiographic findings of pediatric foot deformities with general terms without using these specific lines and angles, others described them with less concern about their role in the diagnosis and definition of the deformity components, and others mention them in a scattered (non-systematic) manner.

This article aimed to review the main currently described lines and angles used in interpreting the plain radiographic film for assessment of pediatric foot deformities. The objective was to gather these lines and angles in a single article and arrange them in a systematic way to facilitate the process of assessment of the pediatric foot (as a whole) for deformities.