Co esponding au ho : And es Felipe Mayo ga Chapa o
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Böhle and Gissane angles: App oxima ion o no mal alues in he Colombian
popula ion
And es Felipe Mayo ga Chapa o 1, *, Nicolas Eladio Esgue a Romano 1, Jhon Alexande Muñoz Pin o 1,
Gab iela Lozada Vega 2, And ea Ca olina Bus os Cas ellanos 2 and Albe o En ique Vieco Reyes 3
1 Residen in O hopedics and T auma ology, Facul y o Heal h Sciences, Uni e sidad Lib e, Ba anquilla, Colombia.
2 Medical S uden , Facul y o Heal h Sciences, Uni e sidad Lib e, Ba anquilla, Colombia.
3 Foo and Ankle Su geon, O hopedic Su geon, Clínica Ibe oamé ica, Ba anquilla, Colombia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 762-766
Publica ion his o y: Recei ed on 14 Ma ch 2025; e ised on 03 May 2025; accep ed on 06 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1734
Abs ac
In oduc ion: Calcaneal ac u es a e a common a sal inju y, which emains a diagnos ic and he apeu ic challenge.
Al hough omog aphy has op imized hei e alua ion, he measu emen o Böhle and Gissane angles on con en ional
adiog aphs emains essen ial o ini ial diagnosis and ollow-up. The no mal alues o hese angles may a y acco ding
o he popula ion, he p esen s udy is looking o e e ence alues in he Colombian popula ion.
Me hodology: A desc ip i e c oss-sec ional s udy was pe o med in an imaging cen e in Ba anquilla, Colombia.
La e al ankle adiog aphs o pa ien s olde han 18 yea s wi hou bone al e a ions we e analyzed. Böhle and Gissane
angles we e measu ed by wo in es iga o s independen ly on wo di e en occasions. Measu es o cen al endency
and dispe sion we e calcula ed. S uden 's - es s we e applied o e alua e di e ences by sex, la e ali y and age g oup.
Resul s: 240 adiog aphs o 189 pa ien s we e e alua ed. The mean Böhle angle was 31.36° ± 6.03 and he mean
Gissane angle was 117.23° ± 7.74. No s a is ically signi ican di e ences we e obse ed acco ding o sex, la e ali y o
age g oup (p > 0.05).
Discussion: The alues ob ained a e simila o hose epo ed in La in Ame ican s udies, al hough sligh ly lowe han
he classic anges desc ibed in No h Ame ican and Eu opean popula ions. These indings ein o ce he impo ance o
ha ing local e e ence alues o adiog aphic e alua ion o he calcaneus.
Conclusions: The Böhle and Gissane angles in he Colombian popula ion p esen alues compa able o hose o o he
La in Ame ican popula ions. I is sugges ed o use hese alues as a e e ence in local clinical p ac ice o a mo e accu a e
diagnosis
Keywo ds: Calcaneal F ac u es; Radiog aphy; O hopedics; An h opome y; Ana omy
1. In oduc ion
Calcaneal ac u es ep esen he mos common a sal inju y, usually seconda y o high-ene gy auma [1]. Thei
complex ana omy, associa ed so issue complica ions and he mul iple he apeu ic s a egies a ailable make hese
ac u es a challenge o o hopedis s [2]. Since hei ini ial desc ip ion, Böhle and Gissane angles ha e been used o
he diagnosis, p eope a i e planning and pos ope a i e ollow-up o calcaneal ac u es, especially in se ings whe e
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 762-766
763
compu ed omog aphy (CT) is no immedia ely a ailable (Figu es 1a and 1b) [3,4]. Al hough he ou ine use o CT has
allowed o mo e de ailed analysis, adiog aphy emains he ini ial me hod o e alua ion. [5]
Figu e 1 a Böhle angle measu emen , b. Gissane angle measu emen
Classically, no mal alues o he Böhle and Gissane angles ha e been s ipula ed o be be ween 20-40° and 120-140°
espec i ely. Wo ks such as hose o Hause and K oeke in he Uni ed S a es, Loucks and Buckley in Canada and
Shouk y in Egyp ha e a emp ed o cha ac e ize mo e p ecisely hese alues in hei popula ion [6-8]. As o he La in
Ame ican popula ion he e a e ew an eceden s wi h he same objec i e, he closes was pe o med in he B azilian
popula ion by Lou o and collabo a o s whe e hey ind alues o he Böhle angle a 32.6°±6.1 and Gissane a
110.6°±11.9 [9]. De e mining he e e ence alues in he Colombian popula ion and compa ing hem wi h hose al eady
es ablished in he li e a u e allows o an objec i e diagnosis and a sea ch o esul s close o no mali y co esponding
o ou con ex
2. Ma e ial and me hods
A desc ip i e c oss-sec ional s udy was ca ied ou in an imaging cen e in Ba anquilla, Colombia. The s udy included
la e al ankle adiog aphs o pa ien s olde han 18 yea s wi h adequa e echnique o he measu emen o Böhle and
Gissane angles. Radiog aphs wi h os eosyn hesis de ices, congeni al o acqui ed de o mi ies, sequelae o p e ious
ac u es o a i ac s ha p e en ed a co ec measu emen we e excluded (Figu e 2). Measu emen s we e pe o med
independen ly by wo in es iga o s, on wo sepa a e occasions, using calib a ed digi al measu emen so wa e. Fo
s a is ical analyses, measu emen s wi h a alue o 0 we e excluded. The mean, median, mode and s anda d de ia ion o
he Böhle and Gissane angles we e calcula ed. Fo compa ison be ween sex, la e ali y and age g oups, S uden 's - es s
we e applied. A alue o p < 0.05 was conside ed s a is ically signi ican .
Figu e 2 Example o adiog aph excluded om he s udy due o ob ious de o mi y
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3. Resul s
A o al o 240 adiog aphs co esponding o 189 pa ien s we e e alua ed: 110 women (58.2%) and 79 men (41.8%). O
he s udies, 138 we e unila e al and 51 bila e al. The igh oo was e alua ed in 130 cases and he le oo in 110 cases.
The age o he pa ien s anged om 18 o 85 yea s, wi h a mean o 46 ± 16.2 yea s (Table 1). The Böhle angle had a
mean o 31.36° ± 6.03, wi h a ange be ween 16.1° and 44°, while he Gissane angle p esen ed a mean o 117.23° ± 7.74.
When compa ing he angles be ween sexes, no s a is ically signi ican di e ences we e ound (p > 0.05). No we e
signi ican di e ences ound when compa ing be ween igh and le ee (p > 0.05) o be ween he di e en age g oups
(p > 0.05). The a o emen ioned esul s a e summa ized in Table 2 and 3.
Table 1 Cha ac e is ics o he adiog aphs o he pa ien s e alua ed. n= 189
To al (n)
To al (%)
Age (yea s)
18 - 29
30
15.9%
30 - 39
45
23.8%
40 – 49
34
17.9%
50 – 59
37
19.5%
60 – 69
26
13.7%
70 – 79
13
6.8%
80 – 89
4
2.1%
189
100%
Sex
Female
110
58.2%
Male
79
41.8%
189
100%
La e ali y
Righ
130
54.1%
Le
110
45.9%
240
100%
Table 2 Mean esul o he Böhle and Gissane angles measu ed
Righ (°)
Le (°)
To al Mean (°)
S anda d De ia ion
Mean Böhle
30.81
31.91
31.36
6.03
Mean Gissane
117.83
116.64
117.23
7.74
Table 3 Compa ison o he Böhle and Gissane angles measu ed acco ding o age
Female (°)
Male (°)
T S uden
P Value
Mean Böhle
30.96
32.01
-1.187
0.8816
Mean Gissane
117.6
116.6
1.13
0.8701
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4. Discussion
The e alua ion o calcaneal ac u es con inues o ely hea ily on con en ional adiog aphic s udies, despi e he ad en
o compu ed omog aphy as a diagnos ic ool. The Böhle and Gissane angles, ini ially desc ibed in a con ex p io o he
widesp ead use o CT, con inue o ha e clinical ele ance o he diagnosis, su gical planning and ollow-up o calcaneal
ac u es [1,3,4].
In he p esen s udy, he a e age alues o he Böhle angle (31.36° ± 6.03) and Gissane angle (117.23° ± 7.74) we e
consis en wi h hose epo ed in La in Ame ican s udies, such as ha o Lou o e al. in B azil, who ound an a e age
Böhle angle o 32.6° ± 6.1 and Gissane angle o 110.6° ± 11.9 [9]. In con as , ou esul s showed sligh ly lowe alues
wi h espec o hose epo ed in No h Ame ican and Eu opean popula ions, whe e he Gissane angle ends o be close
o 120°-130° [6,7]. These di e ences ein o ce he hypo hesis ha ana omical pa ame e s a y be ween popula ions,
possibly in luenced by gene ic, en i onmen al, e hnic and physical de elopmen al ac o s.
A s eng h o ou wo k is he me hodology employed wi h dual analysis by wo independen obse e s and epea ed
measu emen s, a s a egy ha imp o es he ep oducibili y o he esul s and minimizes measu emen bias. In addi ion,
he inclusion o a ela i ely la ge sample, in compa ison wi h p e ious s udies in La in Ame ica and wo ldwide,
inc eases he s a is ical powe o he s udy and he eliabili y o he con idence in e als ob ained.
Ano he a o able ea u e is he igo ous applica ion o inclusion and exclusion c i e ia, elimina ing adiog aphs wi h
ana omical al e a ions, a i ac s o p e ious pos - auma ic condi ions, ensu ing ha he measu emen s e lec
unal e ed no mal ana omical alues.
Howe e , his s udy also has ele an limi a ions. The single-cen e design limi s he ex apola ion o he indings o he
en i e Colombian popula ion, especially conside ing he exis ing e hnic di e si y in he coun y. Secondly, addi ional
ac o s ha could ha e an impac on anginal measu emen s, such as heigh , weigh , body mass index, occupa ion o
habi ual physical ac i i y o he pa ien s, we e no e alua ed. P e ious s udies ha e sugges ed ha hese ac o s may
in luence bone mo phology and adiog aphic measu emen s [10,11].
Addi ionally, a o mal in a- and in e obse e ag eemen analysis (e.g., using in aclass co ela ion coe icien s) was
no pe o med, which would ha e u he s eng hened he alida ion o he measu emen s made. Also, he echnical
quali y o some adiog aphs, inhe en in he e ospec i e ma e ial, may ha e a ec ed he accu acy o some
measu emen s.
Finally, al hough ou s udy ocused on es ablishing ana omical e e ence alues, nei he clinical no unc ional
co ela ion wi h hese alues was included. Fu u e s udies could in es iga e whe he small di e ences in Böhle and
Gissane angles in heal hy indi iduals co ela e wi h clinical symp oms, ac u e p edisposi ion, o su gical ou comes in
auma cases.
In conclusion, ou esul s suppo he need o local e e ence pa ame e s o imp o e diagnos ic accu acy and su gical
planning o calcaneal ac u es in he Colombian popula ion. This wo k es ablishes a solid basis o u u e mul icen e
in es iga ions, wi h la ge samples and clinical co ela ions, which will u he s eng hen he ana omical knowledge
applied o he ea men o his complex pa hology
5. Conclusion
The a e age alues o Böhle 's angle (31.36°) and Gissane's angle (117.23°) in he Colombian popula ion a e simila o
hose epo ed in La in Ame ican popula ions. The e we e no signi ican di e ences acco ding o sex, la e ali y o age.
The use o hese e e ence alues in local clinical p ac ice is sugges ed.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
The au ho s decla e ha hey ha e no con lic s o in e es o disclose.
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766
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
Re e ences
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