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      FOOT ALIGNMENT IN SYMPTOMATIC NATIONAL FOOTBALL LEAGUE (NFL) ATHLETES: A WEIGHTBEARING CT ANALYSIS Translated title: ALINHAMENTO DO PÉ EM ATLETAS SINTOMÁTICOS DA NFL: UMA ANÁLISE DE TOMOGRAFIA COMPUTADORIZADA COM CARGA

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          ABSTRACT

          Objective:

          Our aim was to describe the foot alignment in National Football League (NFL) players with different symptomatic foot and ankle pathologies using weightbearing cone-beam computed tomography (WBCBCT), comparing them to normally aligned feet as control group.

          Methods:

          41 feet (36 active NFL players) were assessed using WBCBCT and compared to 20 normally aligned controls from a normal population. Measurements included: Foot and Ankle Offset (FAO); Calcaneal Offset (CO); Hindfoot Alignment Angle (HAA); angle between inferior and superior facets of the talus (Inftal-Suptal); angle between inferior facet of the talus and the horizontal/floor (Inftal-Hor); Forefoot Arch Angle (FAA); navicular- and medial cuneiform-to-floor distance.

          Results:

          NFL athletes showed a neutrally aligned hindfoot when compared to controls (FAO: 1% vs 0.5%; CO: 2.3 mm vs 0.8 mm; HAA: 2.9° vs 0.8° in two groups, with all p > 0.05) and a normal morphology of the subtalar joint (no difference in Inftal-Suptal and Inftal-Hor angles). Conversely, in athletes we found a decreased medial longitudinal arch (FAA: 15° vs 18.3°, p = 0.03) with smaller navicular (38.2 mm vs 42.2 mm, p = 0.03) and medial cuneiform (27 mm vs 31.3 mm, p = 0.01) mean distances to the floor when compared to controls.

          Conclusion:

          In our series, NFL players presented a lower medial longitudinal arch than controls but a neutrally aligned hindfoot. WBCBCT may help shed light on anatomical risk factors for injuries in professional players. Level of Evidence III, Retrospective comparative study.

          RESUMO

          Objetivo:

          Descrever o alinhamento do pé em jogadores da National Football League (NFL) com diferentes patologias sintomáticas do pé e tornozelo usando a tomografia computadorizada de feixe cônico com suporte de peso (weightbearing cone-beam computed tomography - WBCBCT), e comparar as medidas a grupo controle de voluntários com pés de alinhamento normal.

          Métodos:

          Quarenta pés (36 jogadores ativos da NFL) foram avaliados usando WBCBCT e comparados com 20 controles da população normal. As medidas incluíram: Offset do pé e tornozelo(FAO); Calcâneo Offset (CO); ângulo de alinhamento do retropé (HAA); ângulo entre as facetas inferior e superior do tálus (Inftal-Suptal); ângulo entre a faceta inferior do tálus e o solo (Inftal-Hor); ângulo do arco do antepé (FAA); distância navicular/solo e cuneiforme medial/solo.

          Resultados:

          Atletas da NFL mostraram retropé com alinhamento neutro quando comparados aos controles (FAO: 1% vs. 0,5%; CO:2,3mm vs. 0,8 mm; HAA: 2,9° vs. 0,8°, com todos p > 0,05) e morfologia normal da articulação subtalar (sem diferença nos ângulos Inftal-Suptal e Inftal-Hor). Por outro lado, observamos nos atletas profissionais um arco longitudinal medial diminuído (FAA: 15° vs. 18,3°,p=0,03) com distâncias médias do navicular/solo (38,2 mm vs. 42,2 mm, p = 0,03) e do cuneiforme medial/solo (27 mm vs. 31,3 mm, p = 0,01) menores quando comparados ao grupo controle.

          Conclusão:

          Em nossa série, os jogadores da NFL apresentaram um arco longitudinal medial diminuído em relação aos controles, mas um retropé neutro. WBCBCT pode ajudar a esclarecer os fatores de risco anatômicos para lesões em jogadores profissionais de elite. Nível de Evidência III, Estudo retrospectivo comparativo.

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          Most cited references27

          • Record: found
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          The effect of foot structure and range of motion on musculoskeletal overuse injuries.

          The purpose of this prospective study was to determine whether an association exists between foot structure and the development of musculoskeletal overuse injuries. The study group was a well-defined cohort of 449 trainees at the Naval Special Warfare Training Center in Coronado, California. Before beginning training, measurements were made of ankle motion, subtalar motion, and the static (standing) and dynamic (walking) characteristics of the foot arch. The subjects were tracked prospectively for injuries throughout training. We identified risk factors that predispose people to lower extremity overuse injuries. These risk factors include dynamic pes planus, pes cavus, restricted ankle dorsiflexion, and increased hindfoot inversion, all of which are subject to intervention and possible correction.
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            3D Biometrics for Hindfoot Alignment Using Weightbearing CT.

            Hindfoot alignment on 2D radiographs can present anatomical and operator-related bias. In this study, software designed for weightbearing computed tomography (WBCT) was used to calculate a new 3D biometric tool: the Foot and Ankle Offset (FAO). We described the distribution of FAO in a series of data sets from clinically normal, varus, and valgus cases, hypothesizing that FAO values would be significantly different in the 3 groups.
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              • Abstract: found
              • Article: not found

              Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography.

              The 3-dimensional nature of adult acquired flatfoot deformity can be challenging to characterize using radiographs. We tested the hypothesis that measurements on weight-bearing (WB) cone-beam computed tomography (CT) images were more useful for demonstrating the severity of the deformity than non-weight-bearing (NWB) measurements.
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                Author and article information

                Journal
                Acta Ortop Bras
                Acta Ortop Bras
                aob
                Acta Ortopedica Brasileira
                ATHA EDITORA
                1413-7852
                1809-4406
                May-Jun 2021
                May-Jun 2021
                : 29
                : 3
                : 118-123
                Affiliations
                [1 ]Hospital for Special Surgery, Department of Orthopedics, Foot and Ankle Surgery, New York, NY, United States of America
                [2 ]University Federico II of Naples, Department of Public Health, Orthopedics and Traumatology Unit, Napoli, NA, Italy
                [3 ]Clinique de l’Union, Foot and Ankle Surgery Center, Saint-Jean, France
                [4 ]Universidade de São Paulo, Department of Orthopedics, Foot and Ankle Surgery, São Paulo, SP, Brazil
                Author notes
                [Correspondence: ] Alessio Bernasconi. Hospital for Special Surgery, 523 East 72nd Street, New York, NY, United States of America, 10023. alebernas@gmail.com

                AUTHORS’ CONTRIBUTIONS: Each author contributed individually and significantly to the development of this article. AB: Study concept and design, manuscript drafting and revision, numerical analysis and interpretation of data, final approval of the version to be published, agreement for all aspects of the work, study supervision; CCN: Study concept and design, manuscript drafting and revision, interpretation of data, final approval of the version to be published, agreement for all aspects of the work; LR: Manuscript drafting and revision, interpretation of data, final approval of the version to be published, agreement for all aspects of the work; FL: Manuscript drafting and revision, final approval of the version to be published, agreement for all aspects of the work; ALGS: Manuscript drafting and revision, interpretation of data, final approval of the version to be published, agreement for all aspects of the work; MJO’M: Study concept and design, manuscript drafting and revision, interpretation of data, final approval of the version to be published, agreement for all aspects of the work, study supervision.

                All authors declare no potential conflict of interest related to this article.

                Author information
                http://orcid.org/0000-0002-9427-3178
                http://orcid.org/0000-0001-6037-0685
                http://orcid.org/0000-0002-3469-4640
                http://orcid.org/0000-0002-0163-6516
                http://orcid.org/0000-0002-6672-1869
                http://orcid.org/0000-0002-3412-6512
                Article
                10.1590/1413-785220212903236709
                8266275
                34290556
                8bd04529-16d2-4611-bfb1-353ef81dd8c3

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 16 April 2020
                : 20 August 2020
                Page count
                Figures: 3, Tables: 2, Equations: 0, References: 20, Pages: 6
                Categories
                Original Article
                Foot and Ankle

                foot,athletes,tomography,,altletas,tomografia
                foot, athletes, tomography, , altletas, tomografia

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