Despite the proliferation of wearable and fashionable health & wellness technologies in recent years, fashion and health are not often a harmonious couple. Most of our readers will be keenly aware of the sacrifices made in the name of sophisticated shoe-wear. High heels, more than any other shoe, are the bane of podiatrists who most deal with the corns, Morton’s neuroma and plantar fasciitis among the numerous conditions which can arise from excessive wear.
Traditionally, 2D X-rays were the tool of choice for podiatrists and orthopedic surgeons assessing foot injury. However, a relatively new product from CurveBeam of Warrington, PA is bringing 3D load-bearing CT scanning to the fight against harmful heels.
CurveBeam’s pedCAT scanner enables office-based foot and ankle scanning in a load bearing posture. The scan takes just over a minute, and image reconstruction is complete within 2 minutes. The system was approved by the FDA in April 2012 and has made its way to the UK this summer.
Researchers at the Institute of Orthopaedics and Musculo-Skeletal Sciences at University College London in conjunction with the Royal National Orthopaedic Hospital are using the system to treat and manage shoe-related symptoms. The researchers have released a video which includes a wince-inducing CT scan of a foot in high heels. Commentary is provided by Mr Andy Goldberg, a consultant orthopedic surgeon who explains the advantages of the system and highlights the particular injuries that can arise from high heels.
A new scanner at the Royal National Orthopaedic Hospital is set to transform the diagnosis and treatment of foot and ankle problems.
For the first time in the UK this new technology will enable doctors to view the foot and ankle in 3D in a full weight bearing position, and if necessary in shoes – helping to identify the source of pain more effectively.
RNOH consultant orthopaedic surgeon and clinical lead of the foot and ankle unit, Dishan Singh said: “Traditionally, we have used 2D X-rays to diagnose foot problems but this only gives us limited information. The new scanner allows us to clearly see how the foot and ankle looks and functions in a weight bearing position, and this will help us treat patients earlier to prevent long term problems”
In this animation, RNOH consultant orthopaedic surgeon Andy Goldberg explains how the 3D scanner is enabling new insights into foot and ankle conditions.
Specialists at UCL found that a number of their female patients (57%) admitted to experiencing severe foot pain as a result of regularly wearing uncomfortable shoes. A further 86% admitted that they found difficulty in finding shoes that could comfortably fit their feet.
Women who regularly wear high heels often suffer from foot and ankle problems as body weight is transferred to the ball of the foot, adding pressure to sesamoids (the tiny pea sized bones under the big toe). Frequent wearing of high heels also squashes the toes, forcing the foot into an unnatural shape, which can cause intense pain and possible long-term damage such as clawing of the toes.
“More than one in five GP visits relate to musculoskeletal problems and many of these are for problems relating to the foot and ankle. There is an established link between high heels and foot pain, but for the first time we are able to see the effect of such shoes on feet in real time” said Mr Goldberg. “In moderation high heels are fine; it’s when worn day in day out that problems could develop”.
| TECHNIQUE | Effective Dose in microseverts (µSv) |
| Daily Background | 8 per day (or 3000 µSv per year) |
| Difference of daily background for high altitude locations (i.e: Denver) vs. sea level | 50% more per day (or 1500 µSv more per year) |
| Coast to coast round trip airline flight | 30** |
| pedCAT Cone Beam CT, medium FOV scan (one foot) pedCAT Cone Beam CT, large FOV scan (two feet) | 2**** 5 |
| Chest Film X-ray | 100** |
| Extremity Film X-ray | 1** |
| Medical CT of Chest | 7000** |
| Dental Medium FOV Medical CT scan (Sonatom 64 slice) | 860* |
| Dental Panoramic (OrthoPhos Plus DS) | 32.2 * |
| Dental Full Mouth Series (Average of various techniques) | 50* |
| Dental Cone Beam CT exam (i-CAT, medium FOV) | 87* |
| 3D Imaging Volume | 20cm (height) x 35cm (diameter) and smaller |
| Resolution | 0.3 mm, 0.37 mm voxel sizes |
| Procedure time | 19-68 seconds |
| Max exposure time | 9 seconds |
| Tube voltage | 100-120 kVp |
| Tube current | 3-5 mA |
| Image detector | Amorphous silicon flat panel |
| Gray scale | 14 bit |
| Dimensions | 4ft (h) x 4ft (w) x 5ft (d) |
| Weight | 400 lbs |
| Power Requirements | 1500VA |
