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Curvebeam

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Weight Bearing CT Imaging for Cuboid Subluxations

Dr. Michael Chin, DPM, presented how weight bearing CT imaging has changed how he evaluates cuboid subluxations at the American Academy of Podiatric Sports Medicine meeting held near the West Point Military Academy campus in early September, 2015. Dr. Chin began using the pedCAT in his office in February of this year. Not much research is out there on how to use plain radiographs to measure cuboid subluxations, Dr. Chin said in his lecture, titled, “Cuboid Syndrome…The Other Side of Heel Pain.” Dr. Chin has tested using a bilateral oblique projection to understand the cuboid/ metatarsal relationship, and has been able to observe a slide between the head of the fourth metatarsal and the head of the cuboid. An MRI could be ordered to see the condition of the peroneal tendon, but the study would be limited because the scan would not be weight bearing, he said.. A traditional CT scan would provide great visualization of the bone, but would provide no information on anatomic alignment. The pedCAT weight bearing CT imaging system is excellent for evaluating stress fractures, sesamoids, periosteal changes, or anything medullar, Dr. Chin said. Another benefit is he can measure the exact degree of subluxation between the cuboid and the fourth metatarsal head. Dr. Chin displayed pedCAT images depicting pre and post-reduction views of a cuboid subluxation. pedCAT scan of a pre-surgical patient with cuboid subluxation. Dr. Chin was able to reduce the subluxation to 2.18 mm. Dr. Chin practices at The Running Institute in Chicago.
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AOFAS Annual Meeting – CurveBeam Symposium Recap

Weight bearing CT is a vital tool for determining the cause of inexplicable pain, and also for avoiding painful surgical complications. That was the takeaway message from a talk by Dr. Phinit Phisitkul, a clinical associate professor of orthopaedics at the University of Iowa. He shared some of his most interesting cases at a CurveBeam sponsored symposium held during the AOFAS Annual Meeting in Long Beach during the evening session. We’ve selected three of his cases to share on this blog: 18-year-old male with Noonan Syndrome & severe flat foot: The patient presented with an unusual amount of pain that was difficult to diagnose on plain X-Ray. A weight bearing CT scan revealed he had a severe deformity – a congenital vertical talus. He also had severe impingement. Vertical Talus - Weight Bearing CT Vertical Talus - Weight Bearing CT Impingement - weight bearing CT Impingement - weight bearing CT 58 year-old male with ankle arthritis: The patient presented with a lot of pain in the ankle joint. A weight bearing CT scan showed a subluxation of the ankle joint and dramatic impingement of the calcaneal fibula. Interestingly, the subtalar joint was in pristine condition. Dr. Phisitkul determined the patient was a good candidate for ankle replacement and hindfoot realignment, and that his subtalar joint could be spared. Calcaneal-fibular impingement and arthritis - Weight Bearing CT Calcaneal-fibular impingement and arthritis - Weight Bearing CT 41-year-old female with Hallux Valgus: A weight bearing CT scan revealed a bone spur on the patient’s first metatarsal head. If the doctor had done a normal release, the spur may have ended up pinching the sesamoid. Instead, he performed a lateral release and excised the bone spur.
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pedCAT: A Positive User Experience

“After using the pedCAT for a year, I am very impressed with how much I need it, and how many different things I use it for,” Dr. Bob Baravarian said at the 2015 Western Foot and Ankle Conference held in Anaheim, Cali. The California Podiatric Medical Association hosted the meeting at the end of June. Dr. Baravarian cited Hallux Rigidus as one example where pedCAT imaging has been helpful because he is able to properly assess the sesamoids. Dr. Baravarian confirmed his practice is realizing positive revenue streams as a result of the device.
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Diagnostic Options for Freiberg’s Avascular Necrosis

The underlying causes of avascular necrosis of the second metatarsal head are not totally understood, but early diagnosis is essential. Delayed treatment can result in a collapse of the articular surface, making treatment more difficult. Dr. Bob Baravarian, DPM, explained his preferred methods for diagnosing the condition in the May 2015 issue of Podiatry Today. An X-Ray will show the overall contour and alignment of the metatarsal head. MRI is one option for a secondary study, but edema and swelling can limit visualization of the surrounding bone region, Dr. Baravarian explained. Weight bearing CT scans, meanwhile, clearly show the bones and joints and how they are aligned. Weight bearing CT is "our go-to imaging study," Dr. Baravarian said in the article. "With adequate diagnostic testing and proper patient and procedure selection, one can treat avascular necrosis of the metatarsal head with good to excellent outcomes," Dr. Baravarian said. Dr. Baravarian is the director of University Foot and Ankle Institute in Los Angeles. His practice offers weight bearing CT imaging services.
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