Calcaneal pitch

The calcaneal pitch is an angle used mainly in the diagnosis and severity grading of flat feet and pes cavus.

Calcaneal pitch annotated in orange/yellow, with its various defining points included

Measurement

Calcaneal pitch is an angle of the calcaneus and the inferior aspect of the foot, with different sources giving different reference points. The first line making up the angle is defined as either:

• The calcaneal inclination axis, extending from the calcaneus by the inferior portion of the calcaneocuboid joint to the inferior border of the calcaneus.^[1]
• Tangential to the inferior distal border of the calcaneus.^[2]

The second line is defined as extending from either of the two above to either of the following:

• The inferior border of the head of the fifth metatarsal bone.^[1]
• The inferior aspect of the medial sesamoid bone.^[3]
• Parallel to the ground.^[4]

Interpretation

Calcaneal pitch is increased in pes cavus, with cutoffs ranging from 20° to 32°.^[5] A calcaneal pitch of less than 17° or 18° indicates flat feet.^[6]

References

1. Sinacore, David R; Gutekunst, David J; Hastings, Mary K; Strube, Michael J; Bohnert, Kathryn L; Prior, Fred W; Johnson, Jeffrey E (2013). "Neuropathic midfoot deformity: associations with ankle and subtalar joint motion". Journal of Foot and Ankle Research. 6 (1). doi:10.1186/1757-1146-6-11. ISSN 1757-1146. PMC 3616933.
2. Crim, Julia R.; Manaster, B. J.; Rosenberg, Zehava Sadka (2017). Imaging Anatomy: Knee, Ankle, Foot (2 ed.). Elsevier Health Sciences. p. 468. ISBN 9780323529556.
3. Sam W. Wiesel (2015). "Calcaneal pitch angle segment". Operative Techniques in Orthopaedic Surgery (2 ed.). Lippincott Williams & Wilkins. ISBN 9781496314680.
4. Bourdet, C.; Seringe, R.; Adamsbaum, C.; Glorion, C.; Wicart, P. (2013). "Flatfoot in children and adolescents. Analysis of imaging findings and therapeutic implications". Orthopaedics & Traumatology: Surgery & Research. 99 (1): 80–87. doi:10.1016/j.otsr.2012.10.008. ISSN 1877-0568.
5. "Pes Cavus". University of Washington, Department of Radiology. Last modified: 2016/08/14
6. "Pes Planus". University of Washington, Department of Radiology. Last modified: 2016/08/14