Weight-bearing cone-beam computed tomography (WBCT) allows 3D imaging with full weight-bearing, providing a detailed evaluation of foot and ankle pathologies. WBCT has gained applications in numerous areas of foot and ankle surgery. This study aimed to analyze the effect of WBCT imaging on treating various foot and ankle patients.

Consecutive patients imaged by WBCT of foot and/or ankle from 2018 to 2022 for any indication were included in the study. The number of and the indications for WBCT imaging were collected. The indications for WBCT imaging were divided into different categories: congenital deformity, posttraumatic deformity, acute trauma, routine bony union follow-up, delayed union/non-union, and other indications. The effect of WBCT on the diagnosis and treatment was analyzed.

A total of 439 foot and/or ankle WBCT studies in 333 cases were included. Most of the studies (58%) were performed due to acute trauma. The main effect on treatment was establishing previous treatment choices (48%). A change in the diagnosis or treatment was found in 37% of the cases. There was a significant association between the effect of the WBCT imaging and indication category (χ² = 110, P < .001) and between any change of treatment or diagnosis and indication category (χ² = 29, P < .001). Change in treatment was most common in posttraumatic deformity and least common in routine bony union. The type of acute trauma was significantly associated with outcome (χ² = 108, P < .001).

WBCT has the potential to substantially affect the management of various foot and ankle patients, implying clinical relevance.