Speaker: Weight-bearing CT will become the ‘standard of care’ in foot and ankle surgery
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With the body of literature growing fast, weight-bearing CT will become the standard of care in foot and ankle surgery, according to a presenter at the virtual American Orthopaedic Foot & Ankle Society Annual Meeting.
“What will be the role of weight-bearing CT in foot and ankle surgery? In my opinion, it will definitely change our practice,” Cesar de Cesar Netto, MD, PhD, an assistant professor in the department of orthopaedics at the University of Iowa, said. “It is already happening, and I do not think there is any turning back. There is no way around using WBCT for assessing foot and ankle pathologies.”
de Cesar Netto said many WBCT concepts have already influenced his practice, and he hopes they will help to influence other practices for specific pathologies.
He said WBCT can be of use for hallux valgus, and there are currently 30 publications on PubMed that research the relationship between WBCT and hallux valgus.
“The third dimension for foot and ankle is the coronal plane. X-rays are not really good to show you coronal plane images, and we know that for us to get a view of the metatarsal and the sesamoids we need to do some crazy positioning,” he said. “Now, with a 25-second scan, you can get the whole foot and ankle in very good coronal plane images to assess your metatarsal and your sesamoids.”
Syndesmotic injury and instability are the second pathology in which WBCT can be used, with 23 publications on PubMed, according to de Cesar Netto.
“We still struggle to differentiate syndesmotic injury and syndesmotic instability,” he said. “MRI is probably the gold standard for diagnosing injury, but arthroscopy is still the gold standard for instability. For me, it does not make any sense to do a surgery to tell the patient that [he/she] really needs surgery,” he said.
The last pathology that de Cesar Netto highlighted was adult-acquired flatfoot deformity (AAFD), with 39 publications on PubMed.
“This is probably where most of the ‘money’ is – where most of the literature is,” he said.
When an X-ray overlaps, WBCT allows for full visualization of the subtalar joint, de Cesar Netto said. When deciding treatment of AAFD, WBCT allows the physician to check alignment of the subtalar joint, the amount of subluxation of the posterior and middle facets and the presence of subfibular and sinus tarsi impingements.
“In summary, the body of WBCT literature is definitely growing fast,” de Cesar Netto concluded. “It will be the standard of care, [whether] you like it or not.”
Perspective
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Gregory C. Berlet, MD
Weight-bearing CT (WBCT) imaging is driving a renaissance in foot and ankle surgical care. For years, we have been doing weight-bearing imaging with 2-dimensional X-ray images. The advantages of advanced WBCT imaging cannot be overstated, as the images have rapidly advanced our understanding of relational anatomy of the foot and ankle. Some early examples of this influence are the rotational elements of bunion correction and the articular set angles of the hindfoot in patients with flatfoot deformity. I expect that the ability to acquire WBCT will be the standard of care for advanced foot and ankle care in the near future.
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de Cesar Netto C, et al. Weightbearing CT in foot and ankle surgery. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 10-12, 2020 (virtual meeting).
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