Morphometric measurement of the talus in a South-East Asian population

Morphometric measurement of the talus in a South-East Asian population | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Morphometric measurement of the talus in a South-East Asian population Jun Rui Don Koh, Jun-Nian Beatrice Tan, Ing How Moo, Kinjal Mehta, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6265150/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 26 You are reading this latest preprint version Abstract Background The talus, as the structure bearing the entire compressive load between the leg and the foot, serves an extremely important biomechanical function. Fractures of the talus tend to heal poorly due to its retrograde blood supply, resulting in complications such as avascular necrosis (AVN) and osteoarthritis which lead to the need for eventual fusion surgery or arthroplasty. Computed Tomography (CT) imaging is a valuable tool which for the imaging of bony pathology and can be utilized to evaluate morphometric parameters of the talus. Knowledge of baseline parameters and differences in gender provides insight which will aid not only fracture fixation, but also in the design of implants and prostheses. Objectives This study aims to evaluate talar morphology in the South-East Asian population based on CT imaging, to quantify talar morphometrics. Study Design and Methods A convenience sample study was carried out at our institution by screening patients who had a CT foot or ankle scan performed. Inclusion criteria were patients who were skeletally mature (taken as aged 18 and above) and had imaging of the entire hindfoot of adequate quality. Exclusion criteria included skeletally immature patients (aged 18 and below), and patients who had previous surgery or pathology affecting the imaged foot. Morphometric parameters were measured using a computer software based on anatomical landmarks and current measurements reported in the literature. Measurements were performed independently by three authors, and the mean values for each parameter taken. The talar length was measured at the midline on the sagittal cut. The talar height was measured at 3 points, at the head and neck parallel to the talonavicular joint, and at the maximum height of the dome to the sinus tarsi. The talar width was measured at 4 points, at the width of the dome, the widths of the head, neck, and body taken parallel to the talonavicular joint. Mean values were calculated for each measurement. T-tests were performed to determine if there was any significant difference between measurements taken from male or female patients. Results were deemed to be significant if the p-value was less than 0.05. Results There was a total of 122 patients included in our study, 41 female and 81 male patients. The mean age of the patients was 44.1 years (Range 20 – 91), and the mean BMI was 24.4 (± 5.1). In terms of laterality, there was imaging performed on 57 left, and 65 right feet. Males had larger talar dimensions that females in all parameters measured. Talus length measured 44.72mm in females, compared to 50.72mm in males (p <0.001). Talus height in females was found to be 20.88mm, 17.14mm, and 18.35mm at the head, neck and maximum dome height respectively. In comparison, these measurements in male patients were 24.31mm, 19.80mm, and 21.49mm respectively (p < 0.001 in all measurements). The width of the talar dome was 27.95mm in females, but 31.93mm in males (p <0.001). Talar widths in females were also significantly smaller (p < 0.001) in females compared to males at the talar head, neck, and body, with respective measurements in females of 23.74mm, 21.34mm, and 30.48mm, compared to measurements of 27.93mm, 24.81mm, and 35.07mm in male patients. Conclusions Male patients have significantly larger talar dimensions than female patients in the South-East Asian population. This highlights an importance consideration in the sizing and design of implants and prostheses for use in the 2 patient groups. Talus Foot and Ankle Arthroplasty Imaging Figures Figure 1 Introduction The talus is a complex bone which serves the biomechanical function of bearing the entire compressive load of the body down to the foot. Minor injury affecting this anatomically significant structure can lead to stress in other components of the ankle, and eventually lead to complications such as pain, stiffness, and arthritis [ 1 , 2 ]. In the setting of trauma, good anatomical reduction and fixation is even more critical when it comes to the talus, as complications such as avascular necrosis (AVN) attributable to its poor arterial supply is commonly encountered [ 3 – 5 ]. In the more chronic setting where subtalar fusion is required, anatomical variability of the hindfoot has also led to suboptimal fusion rates [ 6 , 7 ]. The advent of talar replacement as an alternative to fusion surgery for AVN and other pathologies such as malignancy offer advantages such as joint preservation, and improved quality of life, with promising outcomes [ 8 – 12 ]. The use of computed tomography (CT) imaging has proved to an invaluable investigation in the evaluation of bony injuries in the foot and ankle [ 13 ]. CT imaging-based studies have been done in other bones such as the calcaneus to provide additional information which can aid not only in surgical planning, but also for the design of implants and prostheses [ 14 , 15 ]. The aim of our paper is therefore to utilize CT imaging to evaluate morphometric parameters of the talus in the South-East Asian population, as well as determine if morphological differences exist between male and female patients. Materials and Methods A convenience sample study was carried out at our institution by screening patients who had a CT foot or ankle scan performed. Inclusion criteria were patients who were skeletally mature (taken as aged 18 and above) and had imaging of the entire hindfoot of adequate quality. Exclusion criteria included skeletally immature patients (aged 18 and below), and patients who had previous surgery or pathology affecting the imaged foot. Radiographic Parameters Morphometric parameters were measured using a computer software based on anatomical landmarks which were predetermined by the authors with respect to current measurements reported in the literature. Measurements were performed independently by three authors, including a senior orthopedic surgeon (C.K), and a senior musculoskeletal radiologist (C.L.R), and the mean values for each parameter taken. There was a total of 8 parameters which were measured on either sagittal or axial planes. The measured parameters are described below in Table 1 and illustrated in Fig. 1 . Table 1 Description of Landmarks and Methods used for Parameter measurements Parameter Description 1 Talus length A. Measured at the midline on the sagittal cut 2 Talar Height Measured from most superior aspect to the most inferior aspect of the talar head, parallel to the talonavicular joint, on the sagittal cut A. Talar head parallel to talonavicular joint Measured from most superior aspect to the most inferior aspect of the talar neck, parallel to the talonavicular joint, on the sagittal cut B. Talar neck parallel to talonavicular joint Measured from the most superior aspect of the talar dome to the most inferior aspect of the talar dome, just superior to the sinus tarsi, on the sagittal cut C. Maximum height of the dome to the sinus tarsi 3 Talar Width Measured as the maximum width of the talar dome, parallel to the talonavicular joint, on the axial cut A. Talar dome parallel to talonavicular joint Measured as the maximum width of the talar head, parallel to the talonavicular joint, on the axial cut B. Talar head parallel to talonavicular joint Measured as the maximum width of the talar neck, parallel to the talonavicular joint, on the axial cut C. Talar neck parallel to talonavicular joint Measured as the maximum width of the talar body, parallel to the talonavicular joint, on the axial cut D. Talar body parallel to talonavicular joint Statistical analysis Statistical analysis was performed using SPSS software. Mean values and T-tests were calculated to determine if any statistically significant differences were found between male and female talar measurements. Quantitative results are reported as mean (SD) with 95% confidence intervals (CI). Results were statistically significant if the p-value was less than 0.05. All statistical analysis was performed by a single independent statistician. Results There was a total of 122 patients included in our study, 41 female and 81 male patients. The mean age of the patients was 44.1 years (Range 20–91), and the mean BMI was 24.4 (± 5.1). In terms of laterality, there was imaging performed on 57 left, and 65 right feet. Males had larger talar dimensions than females in all parameters measured. A detailed summary of the results is displayed below in Table 2 and illustrated in Fig. 2. Table 2 Morphometric measurement of the talus Measurement All (n = 122) Female (n = 41) Male (n = 81) p-value 1. Length/mm (millimeters) A. Midline on sagittal 48.63 (3.71) 44.72 (2.18) 50.62 (2.58) < 0.001 2. Height/mm A. At head, parallel to talonavicular joint 23.16 (2.61) 20.88 (1.96) 24.31 (2.09) < 0.001 B. At neck, parallel to talonavicular joint 18.90 (2.42) 17.14 (1.87) 19.80 (2.17) < 0.001 C. At body, max height of dome to sinus tarsi 20.43 (2.34) 18.35 (1.45) 21.49 (1.97) < 0.001 3. Width/mm A. Width of dome 30.59 (2.84) 27.95 (2.01) 31.93 (2.19) < 0.001 B. Width of head, parallel to talonavicular joint 26.52 (3.04) 23.74 (1.96) 27.93 (2.47) < 0.001 C. Width of neck, parallel to talonavicular joint 23.64 (3.15) 21.34 (2.29) 24.81 (2.87) < 0.001 D. Width of body, parallel to talonavicular joint 33.53 (3.45) 30.48 (2.56) 35.07 (2.75) < 0.001 All measurements were presented in mean (SD). Talus Length Talus lengths were longer in males compared to females, with an averaged measured length of 50.72mm compared to 44.72mm respectively (p < 0.001). Talus Height Talus heights were found to be taller in males at all 3 of the measured parameters. Talus height in females were found to be 20.88mm, 17.14mm, and 18.35mm at the head, neck and maximum dome height respectively. In comparison, these measurements in male patients were 24.31mm, 19.80mm, and 21.49mm respectively (p < 0.001 in all measurements). Talus Width Talar widths in females were found to be significantly smaller in all 4 of the measured parameters. The width of the talar dome was 27.95mm in females, but 31.93mm in males (p < 0.001). Talar widths in females were also significantly smaller in females compared to males at the talar head, neck, and body, with respective measurements in females of 23.74mm, 21.34mm, and 30.48mm, compared to measurements of 27.93mm, 24.81mm, and 35.07mm in male patients (p < 0.001 in all measurements) Discussion Males had larger talar dimensions than females in all parameters measured, in keeping with current evidence in the literature [16. 17]. Significant differences between genders have also been found in other bones of the feet apart from the talus from various other morphometric studies [ 14 ]. Talar fractures have well known complications with poor outcomes such as post-traumatic osteoarthritis necessitating fusion surgery or arthroplasty [ 18 ]. Knowledge of baseline morphometric parameters can assist with surgical planning to achieve better reduction and restore native anatomy to improve outcomes after fixation. Furthermore, the use of appropriately sized implants is crucial, as they can cause complications such as implant prominence and wound break down. Knowledge of population and gender specific talar morphology can facilitate the design more anatomically fitting implants [ 19 ]. As total talar replacement is becoming increasingly more popular, our research on the morphometric measurements of the talus can lend to improving the design of the prosthesis to be more anatomical, therefore reducing post-operative complications such as impingement and subsidence [ 20 , 21 ]. Currently, the use of CT imaging to provide customized implants is already being performed, with use of the contralateral talus to provide a template to create a prosthesis through 3D printing with good early outcomes [ 22 , 23 ]. Our data serves to establish a baseline within the population which can inform the sizing of devices required. Knowledge of difference in talar morphology between genders also informs the development of gender-specific prosthesis, which have been developed for other joints such as the knee [ 24 ]. There are several limitations in this study. Firstly, there was no correlation body mass index of the subjects with talar morphometric measurements, although current literature has previously reported that there is a poor correlation with large variability [ 25 , 26 ]. Secondly, inter-observer variability was not measured in this study. Lastly, no paired tali from the same patient were compared for symmetry. Existing literature regarding difference between contralateral tali is controversial, with studies reporting both significant and no significant differences between the two sides [ 27 – 29 ]. Conclusion Male patients have significantly larger talar dimensions than female patients in the South-East Asian population. This highlights an importance consideration in the sizing and design of implants and prostheses for use in the 2 patient groups. Further studies may be carried out to determine if there is any difference between patients from different ethnic backgrounds. Declarations Ethical Approval: This study was approved by SingHealth Institutional Review Board (IRB) Institution with approval number 2016/3086 in accordance with Bioethics Advisory Committee Singapore and adhered to the Declaration of Helsinki. Consent: No consent for publication is required as approved by the SingHealth Institutional Review Board (IRB) institution with approval number 2016/3086. Data and Material Availability: The data and materials are available from the corresponding author. Competing Interests: There are no competing interests to declare. Funding Declaration: There was no funding for this paper. Author contributions: All authors were equally involved in the contributions for this paper. 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Sex determination from the talus in a contemporary Greek population using discriminant function analysis. J Forensic Leg Med. 2015;33:14-19. doi:10.1016/j.jflm.2015.03.011 Tochigi Y, Rudert MJ, Saltzman CL, Amendola A, Brown TD. Contribution of articular surface geometry to ankle stabilization. J Bone Joint Surg Am. 2006;88(12):2704-2713. doi:10.2106/JBJS.E.00758 Schuberth JM, Wood DA, Christensen JC. Gutter Impingement in Total Ankle Arthroplasty. Foot Ankle Spec. 2016;9(2):145-158. doi:10.1177/1938640016630059 Taniguchi, A., & Tanaka, Y. (2019). An Alumina Ceramic Total Talar Prosthesis for Avascular Necrosis of the Talus. Foot and ankle clinics, 24(1), 163–171. https://doi.org/10.1016/j.fcl.2018.10.004 Luo, W., Zhang, H., Han, Q., Li, Z., Zhong, Z., Jia, G., Liu, Y., Chang, F., & Wang, J. (2022). Total Talar Replacement With Custom-Made Vitallium Prosthesis for Talar Avascular Necrosis. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6265150","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":440444851,"identity":"1e504ad3-bc82-4631-b594-ff3319309039","order_by":0,"name":"Jun Rui Don Koh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBACCQYeBgMGNhs5fhAvoYB4LWnGkg0gLQZEamFgYDucuOEAiEuMFsn23gPFFWWHGTefX5344YEBgzy/2AH8WqR5ziUYnjmXzmx24+1mCaDDDGfOTsCvRU4ix8Cwsc2azezG2Q0gLQkGt4nTwsxjPOPs5h9EaZGGaHGWMODv3UacLZI9ZwwMG86lGUjc4N1mkWAgQdgvEsd7zAwbymzq+/vPbr75o8JGnl+agBYgYINEhgRYpQRB5SDA/ABM8R8gSvUoGAWjYBSMQAAAsv1CE+Ki5fkAAAAASUVORK5CYII=","orcid":"","institution":"Changi General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jun","middleName":"Rui Don","lastName":"Koh","suffix":""},{"id":440444852,"identity":"fee6993b-8a3a-4e95-9db8-bad94d6af879","order_by":1,"name":"Jun-Nian Beatrice Tan","email":"","orcid":"","institution":"Changi General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jun-Nian","middleName":"Beatrice","lastName":"Tan","suffix":""},{"id":440444853,"identity":"197bc8ba-45c5-465a-9050-e1977625cad9","order_by":2,"name":"Ing How Moo","email":"","orcid":"","institution":"Changi General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ing","middleName":"How","lastName":"Moo","suffix":""},{"id":440444854,"identity":"48490573-ab32-4828-bb47-23901b49cb46","order_by":3,"name":"Kinjal Mehta","email":"","orcid":"","institution":"Changi General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kinjal","middleName":"","lastName":"Mehta","suffix":""},{"id":440444855,"identity":"fbf80a96-ec59-4d7f-8bbc-828d50938a31","order_by":4,"name":"Sir Young James Loh","email":"","orcid":"","institution":"Changi General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sir","middleName":"Young James","lastName":"Loh","suffix":""},{"id":440444856,"identity":"a49f0509-b943-4458-be57-ae8f6d0eb61f","order_by":5,"name":"Le Roy Chong","email":"","orcid":"","institution":"Changi General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Le","middleName":"Roy","lastName":"Chong","suffix":""},{"id":440444857,"identity":"01c1e98a-578f-4ec8-86ac-fc9d8821a7dd","order_by":6,"name":"Kam King Charles Kon","email":"","orcid":"","institution":"Changi General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kam","middleName":"King Charles","lastName":"Kon","suffix":""}],"badges":[],"createdAt":"2025-03-20 01:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6265150/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6265150/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82348321,"identity":"2fba7957-a505-4b9a-b8f7-103e9916526a","added_by":"auto","created_at":"2025-05-09 10:40:51","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":302888,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIllustration of Measured Parameters on Sagittal cut (Left), and Axial cut (Right)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6265150/v1/eecb28fc34fb1d94a57f96ac.jpeg"},{"id":82349810,"identity":"02831571-d0d1-41f6-88b0-fbe57e7129b5","added_by":"auto","created_at":"2025-05-09 10:48:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":780427,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6265150/v1/3fbfb0ae-6d7e-4be5-9ab1-07056aaaff42.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Morphometric measurement of the talus in a South-East Asian population","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe talus is a complex bone which serves the biomechanical function of bearing the entire compressive load of the body down to the foot. Minor injury affecting this anatomically significant structure can lead to stress in other components of the ankle, and eventually lead to complications such as pain, stiffness, and arthritis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In the setting of trauma, good anatomical reduction and fixation is even more critical when it comes to the talus, as complications such as avascular necrosis (AVN) attributable to its poor arterial supply is commonly encountered [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the more chronic setting where subtalar fusion is required, anatomical variability of the hindfoot has also led to suboptimal fusion rates [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The advent of talar replacement as an alternative to fusion surgery for AVN and other pathologies such as malignancy offer advantages such as joint preservation, and improved quality of life, with promising outcomes [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe use of computed tomography (CT) imaging has proved to an invaluable investigation in the evaluation of bony injuries in the foot and ankle [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. CT imaging-based studies have been done in other bones such as the calcaneus to provide additional information which can aid not only in surgical planning, but also for the design of implants and prostheses [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The aim of our paper is therefore to utilize CT imaging to evaluate morphometric parameters of the talus in the South-East Asian population, as well as determine if morphological differences exist between male and female patients.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA convenience sample study was carried out at our institution by screening patients who had a CT foot or ankle scan performed. Inclusion criteria were patients who were skeletally mature (taken as aged 18 and above) and had imaging of the entire hindfoot of adequate quality. Exclusion criteria included skeletally immature patients (aged 18 and below), and patients who had previous surgery or pathology affecting the imaged foot.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eRadiographic Parameters\u003c/h2\u003e \u003cp\u003eMorphometric parameters were measured using a computer software based on anatomical landmarks which were predetermined by the authors with respect to current measurements reported in the literature. Measurements were performed independently by three authors, including a senior orthopedic surgeon (C.K), and a senior musculoskeletal radiologist (C.L.R), and the mean values for each parameter taken. There was a total of 8 parameters which were measured on either sagittal or axial planes. The measured parameters are described below in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of Landmarks and Methods used for Parameter measurements\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTalus length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA. Measured at the midline on the sagittal cut\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTalar Height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeasured from most superior aspect to the most inferior aspect of the talar head, parallel to the talonavicular joint, on the sagittal cut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA. Talar head parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeasured from most superior aspect to the most inferior aspect of the talar neck, parallel to the talonavicular joint, on the sagittal cut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eB. Talar neck parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeasured from the most superior aspect of the talar dome to the most inferior aspect of the talar dome, just superior to the sinus tarsi, on the sagittal cut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eC. Maximum height of the dome to the sinus tarsi\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTalar Width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeasured as the maximum width of the talar dome, parallel to the talonavicular joint, on the axial cut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA. Talar dome parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeasured as the maximum width of the talar head, parallel to the talonavicular joint, on the axial cut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eB. Talar head parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeasured as the maximum width of the talar neck, parallel to the talonavicular joint, on the axial cut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eC. Talar neck parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeasured as the maximum width of the talar body, parallel to the talonavicular joint, on the axial cut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eD. Talar body parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS software. Mean values and T-tests were calculated to determine if any statistically significant differences were found between male and female talar measurements. Quantitative results are reported as mean (SD) with 95% confidence intervals (CI). Results were statistically significant if the p-value was less than 0.05. All statistical analysis was performed by a single independent statistician.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThere was a total of 122 patients included in our study, 41 female and 81 male patients. The mean age of the patients was 44.1 years (Range 20\u0026ndash;91), and the mean BMI was 24.4 (\u0026plusmn;\u0026thinsp;5.1). In terms of laterality, there was imaging performed on 57 left, and 65 right feet. Males had larger talar dimensions than females in all parameters measured. A detailed summary of the results is displayed below in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and illustrated in Fig.\u0026nbsp;2.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMorphometric measurement of the talus\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasurement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Length/mm (millimeters)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA. Midline on sagittal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.63 (3.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.72 (2.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.62 (2.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. \u003cb\u003eHeight/mm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA. At head, parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.16 (2.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.88 (1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.31 (2.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB. At neck, parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.90 (2.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.14 (1.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.80 (2.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC. At body, max height of dome to sinus tarsi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.43 (2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.35 (1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.49 (1.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. \u003cb\u003eWidth/mm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA. Width of dome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.59 (2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.95 (2.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.93 (2.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB. Width of head, parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.52 (3.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.74 (1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.93 (2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC. Width of neck, parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.64 (3.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.34 (2.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.81 (2.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD. Width of body, parallel to talonavicular joint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.53 (3.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.48 (2.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.07 (2.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll measurements were presented in mean (SD).\u003c/p\u003e\n\u003ch3\u003eTalus Length\u003c/h3\u003e\n\u003cp\u003eTalus lengths were longer in males compared to females, with an averaged measured length of 50.72mm compared to 44.72mm respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003ch3\u003eTalus Height\u003c/h3\u003e\n\u003cp\u003eTalus heights were found to be taller in males at all 3 of the measured parameters. Talus height in females were found to be 20.88mm, 17.14mm, and 18.35mm at the head, neck and maximum dome height respectively. In comparison, these measurements in male patients were 24.31mm, 19.80mm, and 21.49mm respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 in all measurements).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTalus Width\u003c/h2\u003e \u003cp\u003eTalar widths in females were found to be significantly smaller in all 4 of the measured parameters. The width of the talar dome was 27.95mm in females, but 31.93mm in males (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Talar widths in females were also significantly smaller in females compared to males at the talar head, neck, and body, with respective measurements in females of 23.74mm, 21.34mm, and 30.48mm, compared to measurements of 27.93mm, 24.81mm, and 35.07mm in male patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 in all measurements)\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eMales had larger talar dimensions than females in all parameters measured, in keeping with current evidence in the literature [16. 17]. Significant differences between genders have also been found in other bones of the feet apart from the talus from various other morphometric studies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTalar fractures have well known complications with poor outcomes such as post-traumatic osteoarthritis necessitating fusion surgery or arthroplasty [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Knowledge of baseline morphometric parameters can assist with surgical planning to achieve better reduction and restore native anatomy to improve outcomes after fixation. Furthermore, the use of appropriately sized implants is crucial, as they can cause complications such as implant prominence and wound break down. Knowledge of population and gender specific talar morphology can facilitate the design more anatomically fitting implants [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs total talar replacement is becoming increasingly more popular, our research on the morphometric measurements of the talus can lend to improving the design of the prosthesis to be more anatomical, therefore reducing post-operative complications such as impingement and subsidence [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Currently, the use of CT imaging to provide customized implants is already being performed, with use of the contralateral talus to provide a template to create a prosthesis through 3D printing with good early outcomes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Our data serves to establish a baseline within the population which can inform the sizing of devices required. Knowledge of difference in talar morphology between genders also informs the development of gender-specific prosthesis, which have been developed for other joints such as the knee [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are several limitations in this study. Firstly, there was no correlation body mass index of the subjects with talar morphometric measurements, although current literature has previously reported that there is a poor correlation with large variability [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Secondly, inter-observer variability was not measured in this study. Lastly, no paired tali from the same patient were compared for symmetry. Existing literature regarding difference between contralateral tali is controversial, with studies reporting both significant and no significant differences between the two sides [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMale patients have significantly larger talar dimensions than female patients in the South-East Asian population. This highlights an importance consideration in the sizing and design of implants and prostheses for use in the 2 patient groups. Further studies may be carried out to determine if there is any difference between patients from different ethnic backgrounds.\u003c/p\u003e"},{"header":"Declarations","content":"\u003col\u003e\n \u003cli\u003eEthical Approval: This study was approved by SingHealth Institutional Review Board (IRB) Institution with approval number 2016/3086 in accordance with Bioethics Advisory Committee Singapore and adhered to the Declaration of Helsinki.\u003c/li\u003e\n \u003cli\u003eConsent: No consent for publication is required as approved by the SingHealth Institutional Review Board (IRB) institution with approval number 2016/3086.\u003c/li\u003e\n \u003cli\u003eData and Material Availability: The data and materials are available from the corresponding author.\u003c/li\u003e\n \u003cli\u003eCompeting Interests: There are no competing interests to declare.\u003c/li\u003e\n \u003cli\u003eFunding Declaration: There was no funding for this paper.\u003c/li\u003e\n \u003cli\u003eAuthor contributions: All authors were equally involved in the contributions for this paper.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAcknowledgements: There are no acknowledgements for this paper.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYeganeh, A., Alaee, A., Boddouhi, B., Behkam-Rad, A., \u0026amp; Shahoseini, G. (2013). Results of surgically treated talar fractures. Chinese journal of traumatology = Zhonghua chuang shang za zhi, 16(6), 361\u0026ndash;364.\u003c/li\u003e\n\u003cli\u003eSproule, J. A., Glazebrook, M. A., \u0026amp; Younger, A. S. (2012). Varus hindfoot deformity after talar fracture. Foot and ankle clinics, 17(1), 117\u0026ndash;125. https://doi.org/10.1016/j.fcl.2011.11.009\u003c/li\u003e\n\u003cli\u003eGross, C. E., Haughom, B., Chahal, J., \u0026amp; Holmes, G. B., Jr (2014). Treatments for avascular necrosis of the talus: a systematic review. Foot \u0026amp; ankle specialist, 7(5), 387\u0026ndash;397. https://doi.org/10.1177/1938640014521831\u003c/li\u003e\n\u003cli\u003eHorst, F., Gilbert, B. J., \u0026amp; Nunley, J. A. (2004). Avascular necrosis of the talus: current treatment options. Foot and ankle clinics, 9(4), 757\u0026ndash;773. https://doi.org/10.1016/j.fcl.2004.08.001\u003c/li\u003e\n\u003cli\u003eHawkins L. G. (1970). Fractures of the neck of the talus. The Journal of bone and joint surgery. American volume, 52(5), 991\u0026ndash;1002.\u003c/li\u003e\n\u003cli\u003eZiegler, P., Friederichs, J., \u0026amp; Hungerer, S. (2017). Fusion of the subtalar joint for post-traumatic arthrosis: a study of functional outcomes and non-unions. International orthopaedics, 41(7), 1387\u0026ndash;1393. https://doi.org/10.1007/s00264-017-3493-3\u003c/li\u003e\n\u003cli\u003eWagner, E., \u0026amp; Melo, R. (2018). Subtalar Arthroscopic Fusion. Foot and ankle clinics, 23(3), 475\u0026ndash;483. https://doi.org/10.1016/j.fcl.2018.04.007\u003c/li\u003e\n\u003cli\u003eTracey, J., Arora, D., Gross, C. E., \u0026amp; Parekh, S. G. (2019). Custom 3D-Printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot. Foot \u0026amp; ankle specialist, 12(1), 39\u0026ndash;48. https://doi.org/10.1177/1938640018762567\u003c/li\u003e\n\u003cli\u003eKatsui, R., Takakura, Y., Taniguchi, A., \u0026amp; Tanaka, Y. (2020). Ceramic Artificial Talus as the Initial Treatment for Comminuted Talar Fractures. Foot \u0026amp; ankle international, 41(1), 79\u0026ndash;83. https://doi.org/10.1177/1071100719875723\u003c/li\u003e\n\u003cli\u003eKurokawa, H., Taniguchi, A., Morita, S., Takakura, Y., \u0026amp; Tanaka, Y. (2019). Total ankle arthroplasty incorporating a total talar prosthesis: a comparative study against the standard total ankle arthroplasty. The bone \u0026amp; joint journal, 101-B(4), 443\u0026ndash;446. https://doi.org/10.1302/0301-620X.101B4.BJJ-2018-0812.R2\u003c/li\u003e\n\u003cli\u003eJennison, T., Dalgleish, J., Sharpe, I., Davies, M., \u0026amp; Goldberg, A. (2023). Total Talus Replacements. Foot \u0026amp; ankle orthopaedics, 8(1), 24730114221151068. https://doi.org/10.1177/24730114221151068\u003c/li\u003e\n\u003cli\u003eOuchi, K., Oi, N., Yabuki, S., \u0026amp; Konno, S. I. (2023). Total Talar Replacement for Idiopathic Osteonecrosis of the Talus: Investigation of Clinical Outcomes, Pain, ADL, QOL. Foot \u0026amp; ankle orthopaedics, 8(1), 24730114231154211. https://doi.org/10.1177/24730114231154211\u003c/li\u003e\n\u003cli\u003eLintz F, Beaudet P, Richardi G, Brilhault J. Weight-bearing CT in foot and ankle pathology. Orthop Traumatol Surg Res. 2021;107(1S):102772. doi:10.1016/j.otsr.2020.102772\u003c/li\u003e\n\u003cli\u003eKoh, D., Tan, B., Mehta, K., Loh, J., Chong, L. R., \u0026amp; Kon Kam King, C. (2024). Morphometric Analysis of the Calcaneus in a Southeast Asian Population. Cureus, 16(4), e58899. https://doi.org/10.7759/cureus.58899\u003c/li\u003e\n\u003cli\u003eLeardini A. (2001). Geometry and mechanics of the human ankle complex and ankle prosthesis design. Clinical biomechanics (Bristol, Avon), 16(8), 706\u0026ndash;709. https://doi.org/10.1016/s0268-0033(01)00022-5\u003c/li\u003e\n\u003cli\u003eZhao DH, Huang DC, Zhang GH, et al. Gender Variation in the Shape of Superior Talar Dome: A Cadaver Measurement Based on Chinese Population. Biomed Res Int. 2018;2018:6087871. Published 2018 Jul 4. doi:10.1155/2018/6087871\u003c/li\u003e\n\u003cli\u003eHe, J. Q., Ma, X. L., Zhang, X., Xin, J. Y., \u0026amp; Li, N. (2016). Three-dimensional Computer-assisted Modeling of Talus Morphology in Chinese Patients. Orthopaedic surgery, 8(3), 383\u0026ndash;392. https://doi.org/10.1111/os.12258\u003c/li\u003e\n\u003cli\u003eDodd A, Lefaivre KA. Outcomes of Talar Neck Fractures: A Systematic Review and Meta-analysis. J Orthop Trauma. 2015;29(5):210-215. doi:10.1097/BOT.0000000000000297\u003c/li\u003e\n\u003cli\u003ePeckmann TR, Orr K, Meek S, Manolis SK. Sex determination from the talus in a contemporary Greek population using discriminant function analysis. J Forensic Leg Med. 2015;33:14-19. doi:10.1016/j.jflm.2015.03.011\u003c/li\u003e\n\u003cli\u003eTochigi Y, Rudert MJ, Saltzman CL, Amendola A, Brown TD. Contribution of articular surface geometry to ankle stabilization. J Bone Joint Surg Am. 2006;88(12):2704-2713. doi:10.2106/JBJS.E.00758\u003c/li\u003e\n\u003cli\u003eSchuberth JM, Wood DA, Christensen JC. Gutter Impingement in Total Ankle Arthroplasty. Foot Ankle Spec. 2016;9(2):145-158. doi:10.1177/1938640016630059\u003c/li\u003e\n\u003cli\u003eTaniguchi, A., \u0026amp; Tanaka, Y. (2019). An Alumina Ceramic Total Talar Prosthesis for Avascular Necrosis of the Talus. Foot and ankle clinics, 24(1), 163\u0026ndash;171. https://doi.org/10.1016/j.fcl.2018.10.004\u003c/li\u003e\n\u003cli\u003eLuo, W., Zhang, H., Han, Q., Li, Z., Zhong, Z., Jia, G., Liu, Y., Chang, F., \u0026amp; Wang, J. (2022). Total Talar Replacement With Custom-Made Vitallium Prosthesis for Talar Avascular Necrosis. Frontiers in bioengineering and biotechnology, 10, 916334. https://doi.org/10.3389/fbioe.2022.916334\u003c/li\u003e\n\u003cli\u003eKim JM, Kim SB, Kim JM, Lee DH, Lee BS, Bin SI. Results of gender-specific total knee arthroplasty: comparative study with traditional implant in female patients. Knee Surg Relat Res. 2015;27(1):17-23. doi:10.5792/ksrr.2015.27.1.17\u003c/li\u003e\n\u003cli\u003eHe JQ, Ma XL, Zhang X, Xin JY, Li N. Three-dimensional Computer-assisted Modeling of Talus Morphology in Chinese Patients. Orthop Surg. 2016;8(3):383-392. doi:10.1111/os.12258\u003c/li\u003e\n\u003cli\u003eStagni R, Leardini A, Ensini A, Cappello A. Ankle morphometry evaluated using a new semi-automated technique based on X-ray pictures. Clin Biomech (Bristol). 2005;20(3):307-311. doi:10.1016/j.clinbiomech.2004.11.009\u003c/li\u003e\n\u003cli\u003eGabrielli AS, Gale T, Hogan M, Anderst W. Bilateral Symmetry, Sex Differences, and Primary Shape Factors in Ankle and Hindfoot Bone Morphology. Foot Ankle Orthop. 2020;5(1):2473011420908796. Published 2020 Mar 6. doi:10.1177/2473011420908796\u003c/li\u003e\n\u003cli\u003eIslam K, Dobbe A, Komeili A, et al. Symmetry analysis of talus bone: A Geometric morphometric approach. Bone Joint Res. 2014;3(5):139-145. Published 2014 May 6. doi:10.1302/2046-3758.35.2000264\u003c/li\u003e\n\u003cli\u003eT\u0026uuml;mer N, Arbabi V, Gielis WP, et al. Three-dimensional analysis of shape variations and symmetry of the fibula, tibia, calcaneus and talus. J Anat. 2019;234(1):132-144. doi:10.1111/joa.12900\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Talus, Foot and Ankle, Arthroplasty, Imaging","lastPublishedDoi":"10.21203/rs.3.rs-6265150/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6265150/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe talus, as the structure bearing the entire compressive load between the leg and the foot, serves an extremely important biomechanical function. Fractures of the talus tend to heal poorly due to its retrograde blood supply, resulting in complications such as avascular necrosis (AVN) and osteoarthritis which lead to the need for eventual fusion surgery or arthroplasty. Computed Tomography (CT) imaging is a valuable tool which for the imaging of bony pathology and can be utilized to evaluate morphometric parameters of the talus. Knowledge of baseline parameters and differences in gender provides insight which will aid not only fracture fixation, but also in the design of implants and prostheses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aims to evaluate talar morphology in the South-East Asian population based on CT imaging, to quantify talar morphometrics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design and Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA convenience sample study was carried out at our institution by screening patients who had a CT foot or ankle scan performed. Inclusion criteria were patients who were skeletally mature (taken as aged 18 and above) and had imaging of the entire hindfoot of adequate quality. Exclusion criteria included skeletally immature patients (aged 18 and below), and patients who had previous surgery or pathology affecting the imaged foot.\u003c/p\u003e\n\u003cp\u003eMorphometric parameters were measured using a computer software based on anatomical landmarks and current measurements reported in the literature. Measurements were performed independently by three authors, and the mean values for each parameter taken. The talar length was measured at the midline on the sagittal cut. The talar height was measured at 3 points, at the head and neck parallel to the talonavicular joint, and at the maximum height of the dome to the sinus tarsi. The talar width was measured at 4 points, at the width of the dome, the widths of the head, neck, and body taken parallel to the talonavicular joint.\u003c/p\u003e\n\u003cp\u003eMean values were calculated for each measurement. T-tests were performed to determine if there was any significant difference between measurements taken from male or female patients. Results were deemed to be significant if the p-value was less than 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a total of 122 patients included in our study, 41 female and 81 male patients. The mean age of the patients was 44.1 years (Range 20 – 91), and the mean BMI was 24.4 (± 5.1). In terms of laterality, there was imaging performed on 57 left, and 65 right feet.\u003c/p\u003e\n\u003cp\u003eMales had larger talar dimensions that females in all parameters measured. Talus length measured 44.72mm in females, compared to 50.72mm in males (p \u0026lt;0.001). Talus height in females was found to be 20.88mm, 17.14mm, and 18.35mm at the head, neck and maximum dome height respectively. In comparison, these measurements in male patients were 24.31mm, 19.80mm, and 21.49mm respectively (p \u0026lt; 0.001 in all measurements). The width of the talar dome was 27.95mm in females, but 31.93mm in males (p \u0026lt;0.001). Talar widths in females were also significantly smaller (p \u0026lt; 0.001) in females compared to males at the talar head, neck, and body, with respective measurements in females of 23.74mm, 21.34mm, and 30.48mm, compared to measurements of 27.93mm, 24.81mm, and 35.07mm in male patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMale patients have significantly larger talar dimensions than female patients in the South-East Asian population. This highlights an importance consideration in the sizing and design of implants and prostheses for use in the 2 patient groups.\u003c/p\u003e","manuscriptTitle":"Morphometric measurement of the talus in a South-East Asian population","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 10:40:47","doi":"10.21203/rs.3.rs-6265150/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-09T06:48:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T19:30:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53247973019486961524133304569955557438","date":"2025-04-08T08:40:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T06:26:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-07T22:00:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-07T18:13:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308961142762376174611738870717861346299","date":"2025-04-07T15:38:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-06T07:54:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-03T16:50:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-02T20:35:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130169175316140338289576480389986415625","date":"2025-04-02T20:30:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-02T10:48:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"298246404414036809261381601259630143125","date":"2025-04-02T10:41:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-02T03:14:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283886080503240428100456810180013241610","date":"2025-04-01T14:23:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198084718078264943309200202219110702624","date":"2025-04-01T12:01:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325201295274968098310508480264375302950","date":"2025-04-01T11:49:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"183578389535329773584271612740567114570","date":"2025-04-01T11:34:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307918363704678963265538195906493905498","date":"2025-04-01T11:08:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95121790963201091677774684229792436538","date":"2025-04-01T11:00:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"182671949737128071823918142254853119862","date":"2025-04-01T10:51:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-01T10:24:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-01T05:31:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-31T21:21:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-28T02:37:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-03-28T02:36:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be2016e7-e9e8-4c89-ad84-28a2042c9172","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-24T03:23:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 10:40:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6265150","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6265150","identity":"rs-6265150","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}