Three-Dimensional Coverage Maps in the Assessment of Chopart Subluxation in Progressive Collapsing Foot Deformity
Authors: Netto Cesar de Cesar , Behrens Andrew , Lalevee Matthieu , Ehret Amanda , Mansur Nacime S. , Anderson Donald D. , Femino John E. , Lintz Francois , Bernasconi Alessio 
Published: January 2022

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 <.05 were considered significant. Results: Changes in coverage percentages of PCFD cases relative to controls are indicated in attached figure 1 . The middle lateral region of the talar head was found to have a 9% increase in coverage in PCFD cases relative to the controls (p = 0.011). The plantar region of the calcaneal-cuboid joint was found to have a 18% decrease in coverage compared to the controls. Except for the dorsal medial regions, the medial side of the talar head saw overall decreases in coverage. However, these values were not statistically significant. On the calcaneus, the plantar region of the calcaneal-cuboid joint was found to have a significant coverage decrease of 18% relative to the controls (p = 0.017). There was also a decrease in coverage observed in the medial region of the calcaneal-cuboid joint and an increase in the dorsal and lateral areas. Conclusion: Our results support the occurrence of significant Chopart joint changes in early flexible PCFD. Increased lateral and decreased medial/plantar talar head coverage point to internal rotation and plantarflexion of the talus. Associated dorsal migration of the cuboid where plantar and medial areas have decreased coverage indicate subluxation through the entirety of the Chopart joint. Novel 3D coverage mapping enabled objective quantification of subluxation though the Chopart joint in early stage PCFD. These findings may assist clinical decision making regarding the restoration of normal joint alignment during PCFD corrections. Further studies are needed to establish thresholds of change associated with degeneration.