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The New Radiographic Evaluation of Hindfoot Alignment
J Korean Foot Ankle Soc. 2012;16:169-174
Published online September 1, 2012
© 2012 J Korean Foot Ankle Soc.

Han, Woo-Yeon;Lee, Ho-Seong;Kim, Won-Kyeong;Ahn, Ji-Yong

Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
Received May 29, 2012; Revised August 12, 2012; Accepted August 21, 2012.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: There are various methods proposed for the evaluation of the hindfoot alignment. However, due to structural calcaneus variances between patients, it is hard to assess this alignment definitively. Thus, this study proposes a new method for evaluating of the hindfoot alignment and its comparisons to the existing current methods. Materials and Methods: This study includes simple weight bearing hindfoot coronal view radiographs of 120 patients, taken between the time period of March 2008 to November 2009. Among the 120 patients, there was a 1:1 ratio of male to female with an average age of 40. The newly proposed method for evaluating this alignment is to draw a moment arm from the point where the sustentaculum tali meets the medial calcaneus border to the most prominent aspect of the lateral process of the calcaneal tuberosity. The angle produced via the intersection of this moment arm to the mid-longitudinal axis of the tibia is found and used to evaluate the hindfoot alignment. The inter and intra-observer reliability was evaluated using the coefficient of intraclass correlation. This study also investigates the comparisons between the newly proposed method to the traditionally used Saltzman et al hindfoot alignment evaluating technique. Results: The newly proposed method has higher inter and intra-observer reliability than the existing traditional Saltzman et al technique. Conclusion: This new method is recommended over the traditionally used Saltzman et al technique as it has a stronger confidence level and is appropriate for assessing hindfoot alignment in simple radiographs.
Keywords : Hindfoot alignment; Evaluation; Interobserver reliability; Intraobserver reliability

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