Foot - measurements

 

 

Calcaneus Bohler's Angle: 

 

 Evaluate calcaneus fracture 

 Formed by the intersection of two lines: 

1 - line from the highest point of calcaneus-cuboid joint until the highest point of the talus-calcaneus joit joint 

2 - line from the last point referred and passes tangentially to the upper edge of the calcaneus tuberosity 

 

• Normal values: 20-40º

 

 

 

 

 

 

 

 

 

 

 

Plantar Arch Angle (Dijan-Annonier): 

 

Weight-bearing x-rays should be taken to better evaluation 

 

Line from the lowest point of calcaneus to the lowest point of talusnavicular joint 

Line from the talus-navicular joint to the lower edge of the lateral sesamoid 

 

Normal values: 120-125º 

Pes planus >128º 

Pes cavus < 120°

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Calcaneal pitch:

 

Angle formed by the horizontal and a line from the base of heel & inferior cortex of calcaneus.
 

if < 20 degrees then pes planus

if > 25 degrees then pes cavus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lateral Talus-Calcaneus Angle (Kite): 

 

Normal values: 25-50º 
Pes planus > 50º 
Pes cavus < 25°
 

 

 

Kho-Wright-Doyle Method: 

 

 

Calcaneus Soft Tissue Thickness Measure: 
 

Line between the anterior and posterior angles of superior surface of calcaneus (A) 
Measure take place on a line perpendicular to the first, and goes from the lowest point of calcaneus to the foot's surface (B) 
 

Normal values: 25mm (M); 23mm(F) 

 

If increased may be related with acromegaly

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hallux Valgus:

 

Weight-bearing anteroposterior (AP) and lateral radiographs of the foot are taken to help assess the deformity and assist in pre-operative planning.

The hallux valgus angle (HVA) (normal < 15˚) and intermetatarsal angle (IMA) (normal < 9˚) are measured.

The distal metatarsal articular angle (DMAA) (normal < 10˚) is the angle between the articular surface of the head and shaft of the first metatarsal.

 

- mild (HVA up to 19˚, IMA up to 13˚)

- moderate (HVA 20˚ to 40˚, IMA 14˚ to 20˚)

- severe (HVA > 40˚, IMA > 20˚).

 

Hallux valgus interphalangeus deformity is present if there is significant angulation between the proximal and distal phalanges.

The relationship of the first metatarsal head to the sesamoids, the size of the medial eminence and the presence of degeneration should also be recorded.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lateral clear space:

 

using the AP view, measure 1 cm above the tibial plafond (yellow line). lateral clear space is distance btwn lateral border of posterior tibia and medial border of fibula (red line) 

 

if > 5 mm then syndesmosis injury

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Valgus/Varus hindfoot

 

 

line through longitudinal axis of talus usually aligns with 1st MT; line through calcaneus intersects 4th MT 

 

 

if < 20 degrees then varus hindfoot

if > 40 degrees then valgus hindfoot

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cavovarus

 

Lateral weight-bearing radiograph of a cavovarus foot. The talo-first-metatarsal angle (angle A, or the Meary angle) is not collinear but rather is apex-dorsal. The forefoot is in equinus relative to the hindfoot, suggesting cavus, and the apex of deformity is within the medial cuneiform. Angle B is the calcaneal pitch and quantifies hindfoot dorsiflexion. There is a double talar dome sign, resulting from talar lateral rotation. Diastasis of the sinus tarsi due to hindfoot inversion is suggested by the see-through sign (arrow). Fig. 6B Anteroposterior weight-bearing radiograph showing a decreased talocalcaneal angle (normal = 25° to 40°), again due to talar lateral rotation. The talonavicular joint is above the calcaneocuboid joint, forming a double density. The foot is narrow, with multiple areas of metatarsal overlap.