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Journal of Anatomy - 2022 - Blythe - Quantifying the ossification and fusion of the calcaneal apophysis using computed2.16 MB
Published VersionCC BY-NC-ND V4.0, Open Access
Journal article
Quantifying the ossification and fusion of the calcaneal apophysis using computed tomography
Journal of Anatomy, Vol.241(2), pp.484-499
2022
PMID: 35468228
Abstract
Knowledge of the anatomical development of the calcaneal apophysis is essential in clinical assessment and management of both paediatric and sub-adult patients presenting with heel pain. Despite this, the current understanding of calcaneal apophyseal development is constrained by the limitations of the imaging modalities used to examine the apophysis, with no current literature reporting the development of the medial and lateral processes. This study aimed to overcome these limitations by investigating the ossification and fusion of the calcaneal apophysis using three-dimensional computed tomography analysis, and statistically predicting the apophyseal developmental stage in contemporary Australian children. The development and fusion status of the apophysis was scored using a novel 11-stage scoring system on 568 multi-slice computed tomography scans (295 females; 274 males) and 266 lateral radiographic scans (119 females; 147 males) from the Queensland Children's Hospital. Multinomial logistic regression along with classification tables and predictive probabilities were then utilised to assess developmental stage likelihood from known age and sex. The apophysis commenced ossification at a mean age of 5.2 years for females and 7.2 years for males, and then elongated to form the apophyseal cap around 10 years for females and 12.4 years for males. Fusion of the apophysis commenced at a mean age of 11.18 years for females and 13.3 years for males, with the earliest age of complete fusion observed at 10 years for females and 14 years for males. The results demonstrate significant sexual dimorphism in ossification and fusion with females developing and fusing significantly earlier. Furthermore, the use of computed tomography in this study allowed for the first time evaluation of the ossification and fusion of the medial and lateral processes of the calcaneus. The medial process formed at a mean age of 9.5 years for females and 10.9 years for males while the lateral process formed at around 9.8 years for females and 11.7 years for males. The medial process demonstrated slower rates of fusion compared to the lateral process. The present study provides Queensland specific standards for assessing the calcaneal apophyseal developmental stage as well as novel predictive regression models for apophyseal stage estimation using known age and sex to aid in the diagnosis of heel pain conditions such as apophysitis or screen for developmental delays in children and subadults.
Details
- Title
- Quantifying the ossification and fusion of the calcaneal apophysis using computed tomography
- Authors
- Connor S. Blythe (Corresponding Author) - Queensland University of TechnologyMikaela S. Reynolds - Queensland University of TechnologyLaura S. Gregory - Queensland University of Technology
- Publication details
- Journal of Anatomy, Vol.241(2), pp.484-499
- Publisher
- Wiley-Blackwell Publishing Ltd.
- Date published
- 2022
- DOI
- 10.1111/joa.13677
- ISSN
- 1469-7580; 0021-8782
- PMID
- 35468228
- Copyright note
- © 2022 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
- Data Availability
- The data that supports the findings of this study are available onrequest from the corresponding author. The data are not publiclyavailable due to privacy or ethical restrictions.
- Grant note
- Queensland University of Technology
- Organisation Unit
- School of Health - Anatomy
- Language
- English
- Record Identifier
- 991087897902621
- Output Type
- Journal article
Metrics
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- Web Of Science research areas
- Anatomy & Morphology