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De Cesar Netto: A clearer picture with weight-bearing 3D analysis
Weight-bearing CT has proved to be the gold-standard approach in identifying flat foot and other foot and ankle deformities. And Cesar de Cesar Netto's expertise in using this advanced imaging method is giving patients the most complete and accurate bone assessments of the lower extremities.
Cesar de Cesar Netto, MD, PhD, an orthopedic surgeon and assistant professor of orthopedics and rehabilitation in the University of Iowa Carver College of Medicine, introduced the CurveBeam weight-bearing CT system at Iowa. It’s one of only 10 in the world that produces standing, 3D imaging of the entire lower extremity (foot, ankle, knee, and hip).
The previous generation of the weight-bearing CT system imaged only up to the knee. This new system, acquired in August 2020, enables the team in the UI Department of Orthopedics and Rehabilitation to provide the most accurate diagnoses and treatment options.
“Sometimes patients have a bad knee or a problem in the hip, and that deformity can put a lot of stress on the foot or the ankle,” de Cesar Netto says. “This is a more complete examination that allows you to consider all the factors.
“The fact that we can examine the lower extremity as a whole and the relationship between all the joints is a game-changer. It’s a three-dimensional, weight-bearing analysis of the whole lower extremity for the first time ever,” he adds.
With roughly 200 publications in academic journals, de Cesar Netto is one of the top experts in weight-bearing CT and has contributed to changes in the terminology that characterizes flat foot deformities.
“By far, the pathology that weight-bearing CT has seen and changed the most is flat foot,” he says. “It can now be easily recognized by the new terminology [progressive collapsing foot deformity] and classification system that was recently proposed, with most of the changes being supported by data from weight-bearing CT imaging publications. [It represents] new ways of thinking about this complex, three-dimensional problem.”
Cesar de Cesar Netto, MD, PhD
The orthopedic surgeon is focused on taking great care of patients, mentoring medical students, residents, and fellows, and collaborating on continuous development of foot and ankle surgery research.
His research has transformed the way he cares for patients with progressive collapsing foot deformities. The weight-bearing CT helps him anticipate when patients have a higher risk for collapse. He can also plan conservative and surgical treatment—with the aim of halting joint degeneration and improving clinical outcomes—with much more accuracy than he could in the past.
“That’s where the research is focused—on identifying factors that predict whether the patient’s foot is collapsing or is about to collapse,” he says. “The problem, the majority of the time, when patients come to see an orthopedic surgeon is: Do they need surgery or not? The holy grail is finding a way to be able to tell people they need surgery, or at least that we need to be more aggressive because their foot is about to collapse or is collapsing.”
Reconstructed foot images
Weight-bearing CT scans show the progressive collapsing foot deformity in a research participant pre-surgery and 12 weeks post-surgery. Images submitted by Cesar de Cesar Netto.
The Brazil native gravitated to the field in 2014 when he was studying at Johns Hopkins University as part of his PhD program at the University of São Paulo. He spent the ensuing years developing expertise in the field as well as forging valuable relationships in the industry before coming to the University of Iowa in 2019, where he helped the university acquire the lower extremity scanner.
Since then, the system has been a boon to UI Health Care’s orthopedics service.
“It is allowing us to visualize things in 3D and reassess diagnoses and treatment of multiple orthopedic problems—how accurate your surgery was, how accurate your treatment was,” he says. “It’s literally changing the specialty.”
Top photo by Liz Martin.
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