To assess the incidence of abnormal internal rotation of the talus in the axial plane in patients with varus ankle osteoarthritis, and to determine whether this incidence differs from the severity of varus ankle osteoarthritis (moderate versus severe).
Materials and methods
We retrospectively evaluated weight-bearing computed tomography (CT) and plain radiographs of 52 ankles with no abnormalities (control group) and 96 ankles with varus osteoarthritis (varus-OA group), which were further stratified into a moderate-OA subgroup (50 ankles) and a severe-OA subgroup (46 ankles). A new radiographic parameter on weight-bearing CT, the talus rotation ratio, was used to assess the rotation of the talus in the axial plane. The normal range of the talus rotation ratio was defined as the 95% prediction interval for talus rotation ratio values in the control group. Abnormal internal rotation of the talus was defined for talus rotation ratio values above the normal range. We determined the incidence of abnormal internal rotation of the talus in the varus-OA group, moderate-OA subgroup, and severe-OA subgroup.
In the varus-OA group, the incidence of abnormal internal rotation of the talus was 45% (43 ankles), which corresponded to an incidence of 32% (16 ankles) in the moderate-OA subgroup and 59% (27 ankles) in the severe-OA subgroup (p = 0.013).
Our study demonstrates that abnormal internal rotation of the talus occurs in patients with varus ankle osteoarthritis, and is more frequently noted in severe than in moderate varus ankle osteoarthritis.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Felson DT. The epidemiology of osteoarthritis: prevalence and risk factors. Osteoarthritis Disord Rosemont Am Acad Orthop Surg. 1995;1324.
Huch K, Kuettner KE, Dieppe P. Osteoarthritis in ankle and knee joints. Semin Arthritis Rheum. 1997;26:667–74.
Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res. 2009;467:1800–6.
Takakura Y, Tanaka Y, Kumai T. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Jt Surg Br. 1995;77–B:50–4.
Lee W-C, Moon J-S, Lee K, Byun WJ, Lee SH. Indications for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity. J Bone Joint Surg Am. 2011;93:1243–8.
Lundberg A. Kinematics of the ankle and foot. In vivo roentgen stereophotogrammetry. Acta Orthop Scand Suppl. 1989;233:1–24.
Siegler S, Chen J, Schneck CD. The three-dimensional kinematics and flexibility characteristics of the human ankle and subtalar joints. I. Kinematics. J Biomech Eng. 1988;110:364.
Ahn T, Yi Y, Cho J, Lee W-C. A cohort study of patients undergoing distal tibial osteotomy without fibular osteotomy for medial ankle arthritis with mortise widening. J Bone Joint Surg Am. 2015;97:381–8.
Cox JS, Hewes TF. “Normal” talar tilt angle. Clin Orthop Relat Res. 1979;(140):37–41.
Veljkovic A, Norton A, Salat P, Saltzman C, Femino J, Phisitkul P, et al. Lateral talar station: a clinically reproducible measure of sagittal talar position. Foot Ankle Int. 2013;34:1669–76.
Lepojärvi S, Niinimäki J, Pakarinen H, Koskela L, Leskelä HV. Rotational dynamics of the talus in a normal tibiotalar joint as shown by weight-bearing computed tomography. J Bone Joint Surg Am. 2016;98:568–75.
Tuominen EKJ, Kankare J, Koskinen SK, Mattila KT. Weight-bearing CT imaging of the lower extremity. AJR Am J Roentgenol. 2013;200:146–8.
Gould N. Graphing the adult foot and ankle. Foot Ankle Int. 1982;2:213–9.
Saltzman CL, El-khoury G. The hindfoot alignment view. Foot Ankle Int. 1995;16:572–6.
Rosner BA. The intraclass coefficient. In: Fundamentals of biostatistics. 7th ed. Boston: Cengage Learning; 2010.
Park MS, Kim SJ, Chung CY, Choi IH, Lee SH, Lee KM. Statistical consideration for bilateral cases in orthopaedic research. J Bone Joint Surg Am. 2010;92:1732–7.
Nosewicz TL, Knupp M, Bolliger L, Henninger HB, Barg A, Hintermann B. Radiological morphology of peritalar instability in varus and valgus tilted ankles. Foot Ankle Int. 2014;35:453–62.
Scharfenberger A, Pearce D, Daniels T. Weight-bearing computer tomography (CT) scan of the feet in pes planus. Orthop Proc. 2008;90–B:88.
Ferri M, Scharfenberger AV, Goplen G, Daniels TR, Pearce D. Weightbearing CT scan of severe flexible pes planus deformities. Foot Ankle Int. 2008;29:199–204.
Greisberg J, Hansen ST, Sangeorzan B. Deformity and degeneration in the hindfoot and midfoot joints of the adult acquired flatfoot. Foot Ankle Int. 2003;24:530–4.
Biswas D, Bible JE, Bohan M, Simpson AK, Whang PG, Grauer JN. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Joint Surg Am. 2009;91:1882–9.
Richards PJ, George J. Diagnostic CT radiation and cancer induction. Skeletal Radiol. 2010;39:421–4.
Sheehan FT, Seisler AR, Siegel KL. In vivo talocrural and subtalar kinematics: a non-invasive 3D dynamic MRI study. Foot Ankle Int. 2007;28:323–35.
Stormont DM, Morrey BF, An KN, Cass JR. Stability of the loaded ankle. Relation between articular restraint and primary and secondary static restraints. Am J Sports Med. 1985;13:295–300.
Earll M, Wayne J, Brodrick C, Vokshoor A, Adelaar R. Contribution of the deltoid ligament to ankle joint contact characteristics: a cadaver study. Foot Ankle Int. 1996;17:317–24.
Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am. 1976;58:356–7.
Ogilvie-Harris DJ, Mahomed N, Demazière A. Anterior impingement of the ankle treated by arthroscopic removal of bony spurs. J Bone Joint Surg Br. 1993;75:437–40.
O’Donoghue DH. Impingement exostoses of the talus and tibia. J Bone Joint Surg Am. 1957;39–A:835–52.
Each author certifies that his or her institution has approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was waived owing to the retrospective design.
Conflicts of interest
The authors declare that they have no conflicts of interest.
About this article
Cite this article
Kim, JB., Yi, Y., Kim, JY. et al. Weight-bearing computed tomography findings in varus ankle osteoarthritis: abnormal internal rotation of the talus in the axial plane. Skeletal Radiol 46, 1071–1080 (2017). https://doi.org/10.1007/s00256-017-2655-0
- Varus ankle osteoarthritis
- Weight-bearing computed tomography
- Axial plane
- Internal rotation