# Improving the Detection, Classification and Treatment of Misaligned Arthritic Ankles

> **NIH VA IK2** · VA PUGET SOUND HEALTHCARE SYSTEM · 2020 · —

## Abstract

Ankle osteoarthritis (OA) is a debilitating and mobility limiting condition. It can commonly stem from
the result of a traumatic injury – such trauma has a high prevalence in military service. If cartilage is not
severely damaged in that trauma, the stability and alignment of the joint may be. Over time, an unstable or
misaligned ankle joint can experience abnormal rates of cartilage wear and tear due to aberrant kinematics.
While OA may take decades to develop, the resulting arthritic state from this trauma will ultimately require
ankle replacement or fusion, consequences with a tremendous financial burden and quality of life impact.
 With regards to alignment, particularly in the coronal plane, current clinical diagnosis relies on static X-
ray of the ankle joint. Static images may not indicate dynamic misalignment during gait. Further, the effect of
wedged insoles, a potential conservative treatment, on the restoration of ankle function is undocumented.
 This proposal aims to use biplane fluoroscopy, an X-ray based dynamic imaging approach, to measure
ankle kinematics in OA subjects (with varus, neutral and valgus ankle alignment) and controls. With this
method, tibio-talar kinematics during gait can be measured. Furthermore, subjects classified as neutral from
their static radiograph, but that exhibit ankle varus or valgus alignment during gait, will be identified.
Improving the accuracy of a diagnostic outcome provides a patient group with additional avenues for
treatment. We will investigate correlations between our 3D kinematics and clinical 2D imaging – to the benefit
of clinical diagnostics. We will also be able to measure the effect of wedged insoles on the restoration of ankle
function. With this in mind, the following aims and methodology are proposed.
 Specific Aim 1: To investigate ankle kinematics in controls and subjects with OA. In
support of Specific Aim 1, 90 ankle OA subjects will be recruited (30 each of varus, neutral or valgus aligned
ankles). We will also recruit 20 control subjects. Subjects will receive CT scans of their feet to quantify bone
geometry (a step necessary for biplane fluoroscopy). Subjects will then be imaged in the biplane system during
gait trials and while wearing neutral study shoes. This will yield tibio-talar kinematics during gait for these
populations. Specific Aim 2: To identify dynamically misaligned ankles in OA subjects who are
currently classified as neutrally aligned using static analysis. We will compare the static X-ray and
the gait kinematics of OA subjects, particularly those with clinically determined neutral alignment. We will
determine what proportion of neutral OA subjects actually exhibit misalignment during gait and are thus
improperly categorized. We will also re-create 2D clinical X-ray views from our 3D data in an attempt to
translate our improvement (with 3D fluoroscopy) to more accurately classify alignment to clinical 2D
diagnostics. Specific Aim 3: To evaluate the potential of...

## Key facts

- **NIH application ID:** 9870793
- **Project number:** 5IK2RX002318-04
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Joseph Iaquinto
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-01-01 → 2023-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9870793

## Citation

> US National Institutes of Health, RePORTER application 9870793, Improving the Detection, Classification and Treatment of Misaligned Arthritic Ankles (5IK2RX002318-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9870793. Licensed CC0.

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