{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:16:19Z","timestamp":1790716579873,"version":"4.1.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,10,16]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Progressive peritalar subluxation (PTS) is part of adult acquired flatfoot deformity (AAFD). We investigated the use of the middle facet as an indicator of PTS using standing, weight-bearing computed tomography (CT) images. We hypothesized that weight-bearing CT would be an accurate method of measuring increased subluxation (\u201cuncoverage\u201d) and incongruence of the middle-facet among patients with AAFD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included 30 patients with stage-II AAFD (20 female and 10 male; mean age, 57.4 years [range, 24 to 78 years]) and 30 matched controls (20 female and 10 male; mean age, 51.8 years [range, 19 to 81 years]) who underwent standing, weight-bearing CT. Two independent and blinded fellowship-trained foot and ankle surgeons measured the amount of subluxation (percentage of uncoverage) and the incongruence angle of the middle facet at the midpoint of its longitudinal length, using coronal-plane, weight-bearing, cone-beam CT images. Intraobserver and interobserver reliabilities were assessed using intraclass correlation coefficients (ICCs). Comparisons were performed using independent t tests or Wilcoxon tests. P values of &lt;0.05 were considered significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Substantial to almost perfect intraobserver and interobserver reliability was observed for both measurements. We found that the middle facet demonstrated significantly increased PTS in patients with AAFD, with a mean value for joint uncoverage of 45.3% (95% confidence interval [CI], 38.5% to 52.1%) compared with 4.8% (95% CI, 3.2% to 6.4%) in controls (p &lt; 0.0001). A significant difference was also found for the incongruence angle, with a mean value of 17.3\u00b0 (95% CI, 14.7\u00b0 to 19.9\u00b0) in the AAFD group and 0.3\u00b0 (95% CI, 0.1\u00b0 to 0.5\u00b0) in controls (p &lt; 0.0001). A joint incongruence angle of &gt;8.4\u00b0 was found to be diagnostic for symptomatic stage-II AAFD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We investigated the use of the middle facet of the subtalar joint as a marker for PTS in patients with AAFD. We confirmed that standing, weight-bearing CT images allowed accurate measurements and that significant differences were found in the percentage of joint uncoverage and the incongruence angle compared with controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>The assessment of the amount of subluxation and incongruence of the middle facet of the subtalar joint represents an accurate diagnostic tool for symptomatic adult acquired flatfoot deformity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.19.00073","type":"journal-article","created":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T06:17:32Z","timestamp":1571293052000},"page":"1838-1844","source":"Crossref","is-referenced-by-count":96,"title":["Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6037-0685","authenticated-orcid":false,"given":"Cesar","family":"de Cesar Netto","sequence":"first","affiliation":[{"name":"The Hospital for Special Surgery, New York, NY"},{"name":"Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6672-1869","authenticated-orcid":false,"given":"Alexandre Leme","family":"Godoy-Santos","sequence":"additional","affiliation":[{"name":"The Hospital for Special Surgery, New York, NY"},{"name":"School of Medicine, University of Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1211-9258","authenticated-orcid":false,"given":"Guilherme H.","family":"Saito","sequence":"additional","affiliation":[{"name":"The Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0163-6516","authenticated-orcid":false,"given":"Francois","family":"Lintz","sequence":"additional","affiliation":[{"name":"Ramsay GDS-Clinique de L\u2019Union, Saint Jean, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7312-5774","authenticated-orcid":false,"given":"Sorin","family":"Siegler","sequence":"additional","affiliation":[{"name":"Drexel University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3412-6512","authenticated-orcid":false,"given":"Martin J.","family":"O\u2019Malley","sequence":"additional","affiliation":[{"name":"The Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4482-5114","authenticated-orcid":false,"given":"Jonathan T.","family":"Deland","sequence":"additional","affiliation":[{"name":"The Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4304-7445","authenticated-orcid":false,"given":"Scott J.","family":"Ellis","sequence":"additional","affiliation":[{"name":"The Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"11","key":"bib1-20230811","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.2106\/00004623-199911000-00006","article-title":"Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot. 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