Clinical Reliability of Classification of www.mkfac.

com
Progressive Collapsing Foot Deformity in
Indian Population
Dr Pradeep Moonot
FRCS (Orth)(UK), MS (Orth),
DNB (Orth), MD (Res)(Lond)
Foot and Ankle Specialist
Mumbai/Hyderabad/Surat/Pune

Dr Nrutik Patel
MS (Orthopaedic), Fellowship in Foot and Ankle Surgery(Mumbai)
Foot and Ankle Specialist
Ahmedabad

Dr Prashant Pawar
DNB (Orthopaedic), Fellowship in Foot and Ankle Surgery(Mumbai)
Mumbai
 INTRODUCTION
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• Classification system has been described for Flatfoot deformity.

• Recently, Consensus Group of American Orthopaedic Foot and
Ankle Society has given classification and termed the whole
spectrum of deformity as “Progressive Collapsing Foot
Deformity” (PCFD)
• In this classification Deformity has been classified in 2 Stages
and 5 Classes.
 Consensus Group
Classification of PCFD www.mkfac.com

Stage of deformity
Stage 1- Flexible
Stage 2- Rigid
Classes
Class A – Hindfoot valgus deformity
[Clinical/Radiological finding- Hindfoot Valgus Alignment, Increased Hindfoot Moment Arm, Hindfoot
Alignment Angle, Foot and ankle offset]
Class B – Midfoot /Forefoot Abduction
[Decreased Talar head coverage, Increased Talonavicular coverage angle, Presence of Sinus Tarsi
Impingement]
Class C – Forefoot Varus / Medial Column Instability
[Increased Talus-1st MT Angle, Planter Gapping 1st TMT joints/NC joints]
Class D – Peritalar Subluxation/ Dislocation
[Significant subtalar joint subluxation/ subfibular impingement]
Class E – Ankle Instability
[Valgus tilting of ankle joint]
 Material & Method
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• Single centeric, prospective study conducted from April 2021 to March

2022 at Mumbai Knee Foot Ankle Clinic, Mumbai, India.
• 38 Patients with total 50 feets were included in our study and
evaluated both clinically and Radiologically.
• Frequencies of each stage and class were assessed in accordance of
PCFD classification.
• Exclusion criteria were defined prior to this study.
• Exclusion criteria were underage patients (age < 17 years) , History of
any hindfoot or midfoot surgery, H/O Neuromuscular diseases and
Peripheral Neuropathy.
 What we studied? www.mkfac.com

• After evaluating each patient clinically and

radiologically, we classified each patient
according to PCFD classification.
• After that we compared our results to the
original published data by author.
Clinical Images www.mkfac.com
 Radiographic Measurement www.mkfac.com

• Saltzmann View
– Hindfoot Alignment Angle (HAA)
– Hindfoot Moment Arm (HMA)
• Foot AP view
– Talonavicular Coverage Angle (TNCA)
– Meary’s Angle ( Talo 1st MT Angle)
• Foot Lateral view
– Meary’s Angle (Talo 1st MT Angle)
– Calcaneal Pitch Angle (CPA)
– 5th MT Height
– Planter Gapping
Radiographic Measurement www.mkfac.com
www.mkfac.com
 Results www.mkfac.com

• Out of total Patients, 32% were male and 68% were female.
• 12 Patients had Bilateral deformity.
• Most Common class was A(92%) followed by Class C(80%).
• The most common subclass was 1ABC (46%) [ 1-Flexible, A-
Hindfoot Valgus, B-Midfoot Abduction, C-Forefoot Varus]
followed by 1AC (24%) and 1ABCD (18%).
• Few patients had isolated deformity.
• Average Hindfoot alignment Angle was 20.9 , average Hindfoot
Moment arm was 8.19 , average Calcaneal Pitch angle was
10.2 , average Lateral meary’s angle was 13.86, average AP
Meary’s angle was 20.64 and average TNCA was 31.65 .
 Comparison www.mkfac.com

• The most common subclass in our study was

1ABC (46%) [ 1-Flexible, A- Hindfoot Valgus,
B-Midfoot Abduction, C-Forefoot Varus]
followed by 1AC (24%) and 1ABCD (18%).
• In consensus group study , most common
subclass was 1ABC (25%) followed by
1ABCD(7%) and 1AB(3.6%).
Outlier 1 www.mkfac.com

In case of PCFD with Hallux valgus Talo 1 st MT Angle is not

giving accurate measurement.

So in every case , it should be better to measure Talo 2 nd MT

Angle
Outlier 2 www.mkfac.com

• 52 year female with Left sided

Normal to high arch with Hindfoot
valgus and Significant Talonavicular
uncoverage
 Outlier 3 www.mkfac.com

62 year female with B/L PCFD with B/L Dorsal

Talonavicular Gapping ( Instead of Planter Gapping)
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• So these 3 cases will not fit in this

classification system.
• We will look forward to improve classification
system and its reliability.
 www.mkfac.com

Thank You