Weight-bearing computed tomography versus standard imaging for the evaluation of complex foot and ankle pathology: a systematic review and meta-analysis on the change in surgical planning and diagnostic accuracy
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20260749Keywords:
Diagnostic accuracy, Foot and ankle, Surgical planning, Standard imaging, Systematic review, Weight-bearing computed tomographyAbstract
Weight-bearing computed tomography (WBCT) is a paradigm change in imaging of the musculoskeletal system, as it records the foot and ankle in physiologic load. This systematic review is a critical appraisal of the diagnostic superiority and its impact on surgical decision-making of WBCT versus standard imaging (SI: radiographs and non-weight bearing CT) for complex foot and ankle conditions. Fifteen studies were included after a search of the literature, adherence to the PRISMA translation. A narrative synthesis and, where possible, a quantitative analysis was conducted. WBCT consistently showed significantly greater magnitude of deformity in conditions such as adult acquired flatfoot deformity (e.g., medial cuneiform-to-floor distance was reduced from 29 mm NWB to 18 mm WB) and highly reliable 3D biometrics (e.g., Foot and Ankle Offset ICCs 0.97 to 0.99). For Lisfranc injuries, WBCT was more sensitive for the detection of subtle instability. Crucially, WBCT was responsible for changing the surgical plan in a pooled 32% of cases (95% confidence interval (CI): 24–41%) with the most common changes made being addition or alteration of procedures. The quality of the included cohort studies was moderate and randomized trials showed some concerns regarding bias. While the technology provides better diagnostic insight and modification of preoperative planning in a large proportion of patients, the supporting evidence is largely from moderate quality, heterogeneous studies with a dearth of long-term outcome data. WBCT is an effective tool for assessment of load-dependent pathology and its incorporation of the diagnostic pathway for complex deformity and instability would seem to be justified.
Metrics
References
Gundtoft PH, Pedersen AB, Viberg B. Incidence, treatment and mortality of ankle fractures: a Danish population-based cohort study. Acta Orthop. 2025;96:203-8. DOI: https://doi.org/10.2340/17453674.2025.43006
de Cesar Netto C, Myerson MS, Day J, Ellis SJ, Hintermann B, Johnson JE, et al. Consensus for the use of weight-bearing CT in the assessment of progressive collapsing foot deformity. Foot Ankle Int. 2020;41(10):1277-82. DOI: https://doi.org/10.1177/1071100720950734
Lintz F, de Cesar Netto C, Barg A, Burssens A, Richter M. Weight-bearing cone beam CT scans in the foot and ankle. EFORT Open Rev. 2018;3(5):278-86. DOI: https://doi.org/10.1302/2058-5241.3.170066
Rojas EO, Mansur NSB, Dibbern K. Weight-bearing computed tomography for assessment of foot and ankle deformities: the Iowa experience. Iowa Orthop J. 2021;41(1):111-9. DOI: https://doi.org/10.1177/2473011421S00419
Kvarda P, Krähenbühl N, Susdorf R. High reliability for weight-bearing CT-based automated 3D measurements to assess progressive collapsing foot deformity. Foot Ankle Orthop. 2022;7(1):247-96. DOI: https://doi.org/10.1177/2473011421S00296
Kalantar SH, Moslehi Mehni S. Evaluation of treatment planning discrepancies: CT versus plain radiographic findings in patients with foot and ankle trauma. BMC Res Notes. 2024;11:362-5. DOI: https://doi.org/10.1186/s13104-024-06902-9
Kumar A, Mishra P, Tandon A, Arora R, Chadha M. Effect of CT on management plan in malleolar ankle fractures. Foot Ankle Int. 2018;39(1):59-66. DOI: https://doi.org/10.1177/1071100717732746
Sheikh HQ. The effect of computerized tomography on operative planning in posterior malleolus ankle fractures. Foot Ankle Surg. 2020;26(6):676-80. DOI: https://doi.org/10.1016/j.fas.2019.08.007
Bernasconi A, Lintz F. Trends in the use of weight-bearing computed tomography. J Clin Med. 2024;13(18):5519. DOI: https://doi.org/10.3390/jcm13185519
Green SP, Al-Saedy S, Thomas EC, Glaser J. The utility of whole body computed tomography in trauma activations and the impact of incidental findings on patient management: A Review. Cureus. 2024;31;16(10):72798. DOI: https://doi.org/10.7759/cureus.72798
Conti MS, Ellis SJ. Weight-bearing CT scans in foot and ankle surgery. J Am Acad Orthop Surg. 2020;28(14):595-603. DOI: https://doi.org/10.5435/JAAOS-D-19-00700
Lintz F, Belvedere C, Leardini A, Bernasconi A, de Cesar Netto C. Recent innovations brought about by weight-bearing CT imaging in the foot and ankle: a systematic review. Appl Sci. 2024;14(13):5562. DOI: https://doi.org/10.3390/app14135562
Talaski GM, Baumann AN, Walley KC, Anastasio AT, de Cesar Netto C. Weight-bearing computed tomography versus conventional tomography for examination of varying degrees of Lisfranc injuries: a systematic review. Foot Ankle Orthop. 2023;8(4):56. DOI: https://doi.org/10.1177/24730114231209767
Richter M, Zech S, Geerling J, Frink M, Knobloch K, Krettek C. Weight-bearing CT of the foot and ankle: results of more than 11,000 scans. Foot Ankle Surg. 2020;26(2):188-93. DOI: https://doi.org/10.1016/j.fas.2019.05.019
Kim J, Lee KB, Song EK, Jung ST, Seon JK. Weight-bearing computed tomography for diseases around the ankle joint. Clin Orthop Surg. 2024;16(2):213-21. DOI: https://doi.org/10.20944/preprints202407.1005.v1
de Cesar Netto C, Schon LC, Thawait GK. Flexible adult acquired flatfoot deformity: comparison of weight-bearing and non-weight-bearing CT measurements. Foot Ankle Int. 2017;38(12):1345-52. DOI: https://doi.org/10.1177/2473011417S000010
Burssens A, Deleu PA, Vanhoenacker FM. Weight-bearing CT in the assessment of hindfoot alignment. Skeletal Radiol. 2018;47(10):1357-66.
Lintz F, Welck M, Bernasconi A. Three-dimensional biometrics for hindfoot alignment using weight-bearing CT. Foot Ankle Int. 2019;40(6):720-30. DOI: https://doi.org/10.1177/1071100719835492
Kido M, Ikoma K, Imai K. Load response of the foot arch under weight-bearing conditions: evaluation using weight-bearing CT. J Orthop Res. 2020;38(9):1987-94.
Barg A, Bailey T, Richter M. Weight-bearing computed tomography of the foot and ankle: emerging technology and clinical applications. Foot Ankle Int. 2018;39(3):376-86. DOI: https://doi.org/10.1177/1071100717740330
de Cesar Netto C, Thawait GK. Multiplanar assessment of hallux valgus deformity using weight-bearing CT. Foot Ankle Int. 2018;39(9):1044-54.
Lintz F, de Cesar Netto C, Barg A. Weight-bearing CT imaging in foot and ankle disorders: a technical and clinical review. EFORT Open Rev. 2020;5(10):640-53. DOI: https://doi.org/10.1177/2473011420S00333
Thawait GK, Wang D, Carrino JA. Weight-bearing CT of the foot and ankle: emerging role in clinical practice. Radiol Clin North Am. 2018;56(6):1037-49.
Baumbach SF, Braunstein M, Regauer M. Changes in surgical decision-making based on weight-bearing CT compared with conventional imaging in foot and ankle pathology. Foot Ankle Surg. 2021;27(4):389-95.
Welck MJ, Lintz F, Cullen NP. Reliability and accuracy of weight-bearing CT in the assessment of hindfoot deformity. Foot Ankle Int. 2018;39(8):941-9.
Downloads
Published
How to Cite
Issue
Section
