Techniques for 3D foot bone orientation angles in weight-bearing from cone-beam computed tomography

Foot Ankle Surg. 2021 Feb;27(2):168-174. doi: 10.1016/j.fas.2020.03.013. Epub 2020 Apr 27.


Background: For the diagnosis and treatment of foot and ankle disorders, objective quantification of the absolute and relative orientation angles is necessary. The present work aims at assessing novel techniques for 3D measures of foot bone angles from current Cone-Beam technology.

Methods: A normal foot was scanned via weight-bearing CT and 3D-model of each bone was obtained. Principal Component Analysis, landmark-based and mid-diaphyseal axes were exploited to obtain bone anatomical references. Absolute and relative angles between calcaneus and first metatarsal bone were calculated both in 3D and in a simulated sagittal projections. The effects of malpositioning were also investigated via rotations of the entire foot model.

Results: Large angle variations were found between the different definitions. For the 3D relative orientation, variations larger than 10 degrees were found. Foot malposition in axial rotation or in varus/valgus can result in errors larger than 5 and 3 degrees, respectively.

Conclusions: New measures of foot bone orientation are possible in 3D and in weight-bearing, removing operator variability and the effects of foot positioning.

Keywords: Anatomical axes; Bones alignments; Cone-beam weight-bearing CT; Digitally Reconstructed Radiographs (DRR); Foot angles; Principal Component Analysis.

MeSH terms

  • Calcaneus
  • Cone-Beam Computed Tomography*
  • Foot Bones / diagnostic imaging*
  • Humans
  • Imaging, Three-Dimensional*
  • Male
  • Metatarsal Bones
  • Patient-Specific Modeling*
  • Weight-Bearing*
  • Young Adult