Summary

The significant difference in calcaneal morphology on CT imaging between male and female patients in the South-East Asian population is an important consideration for surgical planning and selection of appropriately sized implants.

Abstract

Introduction

The calcaneum is the most commonly fractured tarsal bone, accounting for up to 60% of tarsal bone fractures, and 2% of all fractures in the body. With the calcaneus playing an important role in maintaining stable and efficient bipedal gait, sequelae of these injuries have also been associated with potential long-term disability or discomfort, especially if improperly managed. Incorrectly sized implants similarly cause its own set of complications, such as poor fixation, impingement, or implant prominence. This potentially increases the need for revision surgery or implant removal, with increased morbidity to the patient. As such, a thorough understanding of calcaneal morphology is vital to ensure optimal conservative and surgical management of calcaneal pathology.

Radiographic investigations are essential in assessing calcaneal disorders. In evaluation of such a complex 3-dimensional structure, computed tomography (CT) imaging is indispensable. In addition to being widely accessible, it is also less susceptible to errors from radiologic enlargement, foot positioning and rotation, and parallax errors as compared to standard X-ray radiographs.

Aim

This study aims to evaluate calcaneal morphology in the South-East Asian population using CT imaging, and to determine if morphological differences exist between male and female patients.

Methods

Calcaneum measurements were taken from CT scans of 100 patients with intact calcanei, consisting of 34 female and 66 male patients. Patients who have had fractures or previous calcaneum surgery were excluded. SPSS software was used for statistical calculations. Mean values were calculated, and T-tests were performed to establish any significant differences between measurements taken from male and female patients. Results were deemed to have a significant difference if the p-value was less than 0.05.

Results

Males had larger calcanei measurements than females in all parameters included. Calcaneal length in females measured on CT axial views were 66.2mm, compared to 75.2mm in males (p < 0.001). Calcaneal height, measured at the medial wall, was 28.2mm in females and 33.9mm in males (p < 0.001). Calcaneal height measured at the lateral wall was 33.3mm and 38.1 mm in females and males respectively (p > 0.001). Calcaneal width was 33.0mm in females and 36.9mm in males (p < 0.001).
Mean dimensions measured in the total sample gave an axial length of 72.1mm, medial wall height of 32.0mm, lateral wall height of 36.4mm, and width of 35.6mm.
There was no significance difference in the degree of lateral to medial tilt from the calcaneocuboid joint between females and males, with measurements of 32.1° and 33.4° respectively (p > 0.05).

Conclusion

There is a significant difference in calcaneal dimensions between female and male patients in the South-East Asian population. This is important to aid in surgical planning and, in particular, selection of appropriately sized implants.