Three-Dimensional Coverage Maps in the Assessment of Chopart Subluxation in Progressive Collapsing Foot Deformity

Category: Basic Sciences/Biologics; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Progressive collapsing foot deformity (PCFD), formerly termed Adult-Acquired Flatfoot Deformity (AAFD), is a complex 3D deformity characterized by peritalar subluxation (PTS) of the hindfoot through the triple joint complex. In this context, adjacent structures may adopt different positions and boney relations can change, producing areas increased contact or subluxation. The objective of this study was to use 3D distance maps (DMs) and coverage maps (CMs) from weightbearing CT (WBCT) images to assess subluxation across the Chopart joint in PCFD patients. We hypothesized that CMs would show decreased coverage indicative of subluxation through certain regions of the Chopart joint in PCFD patients when compared to the controls. Methods: In this IRB-approved, retrospective case-control study, we analyzed WBCT data of 18 consecutive patients with flexible PCFD and 10 controls. Using principle component analysis, candidate coverage area was divided into nine regions on the talar head and 4 regions on the calcaneal-cuboid (CC) articular surface. Novel 3D distance mapping (DM) technique was used to objectively characterize joint coverage across the entire Chopart joint surface on both the talus and calcaneus. Distance maps were measured in millimeters and colored to highlight covered areas. Areas with distances less than 4mm were defined to be covered, while areas with distances greater than 4mm were considered to be uncovered. Joint coverage was defined as percentage of articular area with DMs lower than 4 mm. Coverage Maps (CM) were created to highlight areas of coverage (teal) versus non- coverage (pink). Comparisons were performed with independent t-tests, assuming unequal variances. P values