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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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Weight Bearing CT in Everyday Practice

“In my opinion, this will be the standard of care in the next couple of years. We are switching from two-dimensional technology to three-dimensional technology and this is really the future of not just foot and ankle, but the future of medicine,” Dr. Alex Tievsky, DPM, said in a lecture he gave at the Graham International Implant Institute 8th Annual Symposium in Miami, on April 17. 2D is beginning to be phased out,” Tievsky said. “Now we’re beginning to see the problem from all angles and all planes, so this is super helpful from that respect.” Dr. Tievsky presented a number of cases where he benefited from access to weight bearing 3D technology in his office. Clinical Case #1 A 50-year-old female presented with bilateral flat feet for 20 years. She had heard about the HyProCure procedure, which corrects hindfoot misalignment through a minimally invasive procedure. She was eager to have the procedure done, no matter the cost. Dr. Tievsky took a pedCAT scan, and found she had a severe talar coalition. talar calc coalition coronal left “How many times do you catch a coalition on an X-Ray? It’s hard,” Dr. Tievsky said. “Sometimes you can see a halo sign, but it’s often missed. On the first visit, I was able to tell her, we either have to resect this coalition or we have to do a fusion. It’s impossible to get this level of information on an X-Ray.” Clinical Case #2 A 16-year old girl came in with first metatarsal head pain. She had already been to two other podiatrists in the last six months, and they had prescribed steroid injections. The pedCAT revealed a fracture on her fibular sesamoid that is extremely easy to miss on X-Ray. fractured sesamoid “Within her first 10 minutes in the office, we had a diagnosis,” Dr. Tievsky said. “We treated her appropriately. We immobilized her for eight weeks and gave her a bone stimulator. And she was pain free, three podiatrists later. She was happy, her mom was happy, and she never came back.” Clinical Case #3 A patient presented with a lateral plantar fasciitis, a talo-tarsal dislocation, back pain for five years, knee pain, and hip pain. A pedCAT revealed she had a tumor in her bone and it was eroding it. “There was no way we would have caught it on X-Ray,” Dr. Tievsky said. “We sent her out for oncology. It could have a malignant tumor, and we could have saved her life.” Cyst Coronal The scan is quick to take and you have a full work-up in about three minutes, Dr. Tievsky said as a closing statement. “This is a super important tool,” he said. “I’m kind of biased. I love this now. I can’t practice without it.”
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Weight Bearing CT Scans for the Evaluation of Implant Arthroplasty Candidates

Weight bearing CT scans can be critical to a proper diagnosis, even for routine procedures. In the following case, for example, a patient’s X-Rays indicated that he would be a good candidate for a metatarsal head hemi-implant arthroplasty. However, when the patient sought a second opinion, a weight bearing CT (pedCAT) scan revealed the true condition of the metatarsal head, and the surgical plan was considerably altered as a result. Click on the blog post title to read the case and view images.
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Dr. Gary Briskin: The pedCAT is the Future

"It's the future - embrace it. It's your future - control it." Dr. Gary Briskin delivered this motivating message at the Foot & Ankle Business Innovations conference in Chicago on Jan. 23. Dr. Briskin, of University Foot & Ankle Institute in Santa Monica, Cali, discussed how the pedCAT weight bearing CT system has improved his practice since his group acquired one last year. His main take-away points were: - The pedCAT gives you the advantage when it comes to diagnosing pathology. "You can solve that Lisfranc case no one else can," Dr. Briskin said. "It opens up the midfoot, which historically has been a problem for us." - The pedCAT allows him to clearly determine if bones and joints are completely fused after surgery. "I do a lot of lapidus procedures," Dr. Briskin said. "My concern; is this patient fused adequately to start bearing weight?" The exact level of fusion is visible with a pedCAT scan 5 - 6 weeks later, and with minimal scatter. - Radiologists like the pedCAT images "I think I'm getting a better CT, because it's weight bearing and I think the quality is far superior. We get all of our CTs read by a radiologist. We have everything sent digitally. And the feedback we get is they are also impressed with the quality of the images."
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