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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2023.tde-01022024-134444
Document
Author
Full name
Eduardo Araujo Pires
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2023
Supervisor
Committee
Santos, Alexandre Leme Godoy dos (President)
Fernandes, Tulio Diniz
Grangeiro, Patricia Moreno
Sanhudo, José Antônio Veiga
Title in Portuguese
Análise do alinhamento clínico e ósseo do retropé de pacientes com pés cavovaros flexíveis em posição ortostática e ao teste do bloco de Coleman através da tomografia computadorizada com carga (WBCT)
Keywords in Portuguese
Exame físico
Fenômenos biomecânicos
Ortopedia
Pé cavo
Procedimentos ortopédicos
Tomografia
Abstract in Portuguese
Introdução: O teste do bloco de Coleman, descrito em 1977, é aceito mundialmente para avaliação da flexibilidade do retropé de pés cavovaros. A literatura mostra que o teste auxilia na decisão do planejamento cirúrgico para correção da deformidade. O objetivo deste trabalho é analisar o alinhamento do retropé de pacientes com pés cavovaros flexíveis em posição ortostática e realizando o teste do bloco de Coleman por meio da tomografia computadorizada com carga (WBCT). Métodos: Vinte pacientes (40 pés) com pés cavovaros flexíveis (Grupo Caso) e 20 indivíduos (40 pés) com pés normais (Grupo Controle) foram submetidos à tomografia computadorizada com carga (WBCT) para avaliação do alinhamento clínico e ósseo do retropé. O Grupo Caso realizou a WBCT em posição ortostática e realizando o teste do bloco de Coleman e o Grupo Controle realizou o exame apenas em posição ortostática. Foram avaliadas as medidas tomográficas do alinhamento do retropé: ângulo clínico de alinhamento do retropé (WBCT-CHAA), índice tornozelo-pé (FAO), ângulo de alinhamento do retropé (HAA), ângulo talocalcâneo (TCA) e ângulo vertical da subtalar (SVA). Resultados: A correlação intraclasse intraobservador média variou de 0,96 a 0,99 e a interobservador variou de 0,61 a 0,98. As médias do FAO observadas no Grupo Controle e Caso foram 2.8% (2,5 3,2) e -3.2% (-3,5 - -2,9) (p<0,05), respectivamente. O WBCT-CHAA médio do Grupo Controle foi 5,6°, do Grupo Caso em posição ortostática foi -5° e do Grupo Caso realizando o teste do Coleman 4,7° (p<0,05). Quando comparado apenas o Grupo Caso em posição ortostática e realizando o teste do bloco de Coleman, a diferença média das medidas observadas HAA, TCA e SVA foram de 0,2°, -0,7° e -0,3°, respectivamente, sem diferença estatística significante. Conclusão: Concluímos que na amostra estudada de pacientes com pés cavovaros flexíveis submetidos ao teste do bloco de Coleman houve diferença média de 9,7° no alinhamento clínico do retropé (p<0,05), mas não houve diferença estatisticamente significante do alinhamento ósseo do retropé quando avaliado de maneira isolada
Title in English
Analysis of the clinical and bone alignment of the hindfoot of patients with flexible cavovarus feet in an orthostatic position and Coleman's block test using weightbearing computed tomography (WBCT)
Keywords in English
Biomechanical Phenomena
Orthopedic Procedures
Orthopedics
Physical Examination
Talipes Cavus
Tomography
Abstract in English
Introduction: Colemans block test, described in 1977, is accepted worldwide to assess the flexibility of the hindfoot in cavovarus feet. The literature shows that the test helps decide the surgical planning to correct the deformity. The objective of this paper is to analyze the alignment of the hindfoot of patients with flexible cavovarus feet in an orthostatic position and Coleman's block test using weight-bearing computed tomography (WBCT). Methods: Twenty patients (40 feet) with flexible cavovarus feet (Case Group) and 20 patients (40 feet) with normal feet (Control Group) underwent weight-bearing computed tomography (WBCT) to assess the clinical and bone alignment of the hindfoot. The Case Group performed the WBCT in an orthostatic position and Coleman's block test, and the Control Group performed the exam only in the standing position. Tomographic measurements of hindfoot alignment were evaluated: clinical hindfoot alignment angle (WBCT-CHAA), foot ankle offset (FAO), hindfoot alignment angle (HAA), talocalcaneal angle (TCA) and subtalar vertical angle (SVA). Results: The mean intraobserver intraclass correlation coefficient ranged from 0.96 to 0.99 and the interobserver correlation ranged from 0.61 to 0.98. The mean FAO observed in the Control and Case Groups were 2.8% (2.5 3.2) and -3.2% (-3.5 - - 2.9) (p <0.05), respectively. The mean WBCT-CHAA for the Control Group was 5.6°, for the Case Group in the standing position it was -5° and for the Case Group at the Coleman test it was 4.7° (p<0.05). When comparing only the Case Group in the orthostatic position and Coleman's block test, the average difference in the observed measures from HAA, ACT and SVA were 0.2°, -0.7° and -0.3°, respectively, with no statistically significant difference. Conclusion: We concluded that in the studied sample of patients with flexible cavovarus feet submitted to Coleman's block test there was a mean difference of 9.7° in the clinical alignment of the hindfoot (p<0.05), but there was no statistically significant difference in the bone alignment of the hindfoot when evaluated in isolation
 
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Publishing Date
2024-02-19
 
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