A revolutionary imaging technique that has so far been used only once in the whole of Switzerland: with the innovative LineUp system from Curve Beam, the Lucerne Foot Center, led by Dr Daniel Krapf, is taking a giant leap forward in diagnostics and patient care – and making headlines in the process. This is because the completely new method of performing three-dimensional X-rays while the patient is bearing weight brings about a lasting improvement, particularly in the orthopedic treatment of patients with complex conditions affecting the foot or ankle. As a result, Dr Krapf’s team has already been able to help many patients in a short space of time using this state-of-the-art technology. No wonder, then, that people from all over Switzerland and abroad are coming to Lucerne!
Dr Krapf – in his role as team doctor for FC Lucerne
Innovative 3D X-ray – the basis for cutting-edge diagnostics and therapy
Dr Daniel Krapf and his medical team at the Lucerne Foot Center have been offering patients the innovative LineUp from Curbe Beam since June 2020. This state-of-the-art technology provides an unprecedented insight into foot anatomy: LineUp is a 3D X-ray machine that, for the first time, enables a complete view of the feet and ankles while standing – thus accurately depicting the load-bearing situation.
Our foot – a highly complex weight-bearing structure
With nearly thirty bones, roughly the same number of joints curved across multiple planes, around twenty muscles and no fewer than a hundred ligaments – the foot, as a weight-bearing organ, is an extremely complex structure. “With a quarter of all our bones and joints, our relatively small feet therefore have an enormous task: they support the entire body and thus perform at a high level day in, day out,” says Dr Krapf. And he immediately adds: “Provided, of course, that they are working properly. Because as soon as the function of the feet is impaired, our mobility is immediately severely restricted.”
The complaints that can arise in this part of the body are just as varied and complex as our feet themselves. “These complaints can be the result of a mechanical problem,” says the specialist, “or the consequence of a metabolic disorder, or a vascular, neurological or spinal condition.” It is therefore important to consult a center specializing in this part of the body for foot complaints.
Before LineUp: 2D X-rays with weight-bearing or 3D CT – but without weight-bearing
It was therefore a significant step for Dr Krapf’s team that he was able to close a diagnostic gap in the analysis of foot and ankle complaints. Until now, three-dimensional imaging of bones and soft tissues in the foot and ankle under load was neither possible nor common practice. And this is precisely what matters when it comes to diagnosis, as many symptoms only occur under load.
Previously, conventional X-rays had to be used to produce only a two-dimensional image of the foot under load – i.e. while standing. However, this was never entirely satisfactory for the perfectionists in Dr Daniel Krapf’s team, just as 3D computed tomography—which must be performed while lying down and cannot replicate the load-bearing situation of the foot or ankle—was not.
Closing this gap took years: it began in December 2014, when the PedCat innovation delivered digital 3D volume tomography while standing. Its successor is now called LineUP: Dr Daniel Krapf became aware of its exceptional capabilities during a clinical placement with Prof. Martinus Richter, who practises as a consultant at the Clinic for Foot and Ankle Surgery at the hospital in Rummelsberg, near Nuremberg, Germany. The Lucerne-based specialist also visited other clinics abroad equipped with LineUp (pedCat) to get a better idea of the technology. This exchange of experiences did not go unnoticed – for Dr Krapf wanted to utilize precisely this innovation for the benefit of his patients at the Lucerne Foot Center.
With LineUp: maintaining the loaded bone position can improve treatment outcomes
“I haven’t regretted this decision for a single second,” he says. Clearly: “Visualizing the load-bearing situation is of immense importance in the treatment of the foot and ankle,” he adds. “The bone position in the foot changes under load – and it is precisely this loaded bone position that needs to be recorded for specific treatment planning.”
The LineUP system from CurveBeam in Warrington, USA, now allows, with the help of the new 3D X-ray imaging technique, any bone deformity and instability of the feet or bones to be recorded and analyzed in detail using 0.3-millimeter-thick slices – “in action”. Projections or specific foot positions that are difficult or impossible to visualize using 2D X-ray imaging no longer need to be created. LineUp thus enables a quick and precise analysis of deformities and positions. As a result, Dr Krapf and his expert team have more information than ever before with minimal effort.
Thanks to this additional information, corrections or even surgical procedures can be planned more accurately and with significantly greater safety. Every step of the treatment is individually tailored to the situation – but patients at this renowned center are already familiar with that. Here, too, the principle naturally applies: the more precise and bespoke the analysis and planning of an operation, the better the surgical outcome – and the faster the recovery process is, as a rule.
LineUp – for the best patient care
But these are not all the advantages of the innovative CurveBeam LineUp, as Dr Krapf emphasises: “As a cone-beam computed tomography system, it involves significantly lower radiation exposure compared to traditional CT procedures,” he says. In addition, Dr Krapf can not only obtain three-dimensional imaging from the data provided by LineUp – he and his team are also able to generate two-dimensional X-ray images from the scans. This eliminates the need for further radiation exposure and also reduces the time required for both patients and medical staff during the examination. “Whereas it used to take a very long time for a patient to get a CT scan appointment after a two-dimensional X-ray due to the workload on the equipment, both images are now available almost immediately,” explains Dr Krapf. This is a particularly significant advantage in emergencies.
Thus, the days of tedious examinations, which tested the patience of both parties, are finally over in Lucerne. This is because the direct examination in the new LineUp is remarkably quick, simple and comfortable: it normally takes less than two minutes to capture all the necessary images in a single pass. To do this, patients simply need to stand on a small blue disc within the cylindrical, knee-high LineUp unit. On the surrounding white ring, there is a stool alongside two supports, in case patients are unable, unwilling or prefer not to stand. Once the patient is correctly positioned on the blue disc, a gray door segment closes the cylindrical device – and the scan can begin. An X-ray tube on one side and a flat-panel sensor on the other now rotate horizontally around the foot.
For Dr Daniel Krapf and his team, the advantages of LineUp are clear: Not only is it time-consuming to ensure the correct positioning of patients during conventional 2D X-rays or CT scans – these are often painful forced positions that, thanks to this innovation, are now a thing of the past and have fortunately become unnecessary. And yet the image quality is impressive in terms of resolution and contrast. The costs incurred by an examination using the innovative CurveBeam LineUp are even significantly lower than standard CT costs. What’s more, the images can be easily reproduced – and when it comes to biomechanical analyzes or research purposes, the new images are superior to traditional X-rays.
Further diagnostic features – and perfect insoles
For the Lucerne Foot Center, LineUp is also a real asset in other respects when it comes to modern patient care. It is not just the new diagnostic possibilities that are impressive: In an affiliated laboratory for orthopedic biomechanics and motion analysis at the Hirslanden Clinic St. Anna Meggen, biomechanical data on individual gait can also be recorded – on an eight-meter-long track fitted with sensitive plates. This enables Dr Krapf and his colleagues to make further assessments regarding joint stress, bone alignment and muscle function in the feet and legs during specific phases of walking. Dr Krapf: “To do this, we attach reflective markers – which are later illuminated by infrared light and filmed – and surface electrodes to the patient’s body, and simultaneously carry out muscle current measurements on the skin as well as pressure and force measurements via the plates on the track.”
These diagnostic options will later enable the production of perfectly custom-made insoles for the feet of diabetics and patients with sensory disturbances. For athletes, too, footwear and training plans can be optimally adapted. Foot and ankle surgery has also been taken to a new level by this innovation, as specialist Dr Krapf explains: “From hallux valgus to flatfoot correction, complex operations can now be optimally planned using this data where indicated.”
Incidentally, the Lucerne Foot Center has had a new location since June 2020: It is situated right in the heart of Lucerne, now at Töpferstraße 5, where it is easily accessible – and, of course, in addition to the innovative LineUp device, the center is fully equipped to address all queries regarding the diagnosis and treatment of foot and ankle conditions.
