Reliability and validity of combined imaging and pressures assessment methods for diabetic feet  Paul K. Commean, BEE, Michael J. Mueller, PhD, PT, Kirk E. Smith, AAS, Mary Hastings, MS, PT, Joseph Klaesner, PhD, Thomas Pilgram, PhD, Douglas D. Robertson, MD, PhD  Archives of Physical Medicine and Rehabilitation  Volume 83, Issue 4, Pages 497-505 (April 2002) DOI: 10.1053/apmr.2002.30923 Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 1 The loading device consists of an adjustable chair and vertical footplate is positioned on the computed tomography scanner table. This configuration allows the foot to be scanned under loads. The subject sits in the loading device and pushes against the vertical plate to apply force to the plantar surface of the foot. While the foot is scanned, the applied force is monitored by a digital force gauge (scale) located under the footplate. By applying a load and concurrently reading the digital display from the scale, the subject can monitor the load being applied. Archives of Physical Medicine and Rehabilitation 2002 83, 497-505DOI: (10.1053/apmr.2002.30923) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 2 AP maximum intensity projection view of the foot with each metatarsal and associated phalanges outlined (white border around each set of bones). The outlines were used to segment the soft tissue under and above each bone, along with bones for each metatarsal and phalanges set. The calcaneus was segmented and used as a reference for making foot-angle measurements. Archives of Physical Medicine and Rehabilitation 2002 83, 497-505DOI: (10.1053/apmr.2002.30923) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 3 A sum projection sagittal view of a control subject's foot placed at an angle relative to the vertical plate. To determine the angle of the calcaneus relative to the forefoot (cal_inc_anat), angle ABC was measured. To determine the angle of the metatarsal relative to the plantar surface of the distal metatarsal head and medial process of the calcaneus (met_inc_anat), the angle BCD was measured. To determine the angle of the medial process of the calcaneus and the plantar surface of the metatarsal head relative to the vertical plate (cal_met_inc_vp), angle BEF was measured. The bright spot under the phalange head just to the right of the letter E is an artifact created from a lead marker attached to the foot's plantar surface. Archives of Physical Medicine and Rehabilitation 2002 83, 497-505DOI: (10.1053/apmr.2002.30923) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 4 A sum projection sagittal view of the foot in a subject who has hammer toes. To determine the angle of the metatarsal's midshaft relative to the vertical plate (met_inc_vp), angle AEF was measured. To determine the angle of the metatarsal's midshaft relative to the midshaft of the phalange (hammer_toe_inc), angle ACG was measured. To determine the metatarsal length (met_length), distance AD along the metatarsal midshaft was measured. The midshaft STT (stt_midshaft) as measured between points HI lies perpendicular to the metatarsal midshaft (HI lies perpendicular to line segment ABD and point B is located at the center of segment AD). Archives of Physical Medicine and Rehabilitation 2002 83, 497-505DOI: (10.1053/apmr.2002.30923) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 5 A sum projection sagittal view of a control subject's foot placed flat against the vertical plate. The STT was measured along line segment AB and between points AB (ends of the segment) under the sesamoid (stt_sesamoid). Line segment AB lies approximately orthogonal to the vertical plate. The STT was measured between points CD under the metatarsal head (stt_met_head). The STT was measured between points EF under the phalanx head to the skin surface (toe_stt). The STT was measured between points EG under the phalanx head to the vertical plate (toe_stt_vp). Archives of Physical Medicine and Rehabilitation 2002 83, 497-505DOI: (10.1053/apmr.2002.30923) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 6 The hallux_valgus angle was measured between line segments ABC. Segment AB is along the midshaft of the metatarsal and segment BC is along the phalanx midshaft. Line segments FG and HI are perpendicular to segment DE. Segments FG and HI touch the distal end of the second metatarsal and first metatarsal, respectively. The distance between parallel line segments FG and HI on DE was measured as the Morton's Index. Archives of Physical Medicine and Rehabilitation 2002 83, 497-505DOI: (10.1053/apmr.2002.30923) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions