The choice of treatment of hallux valgus deformity is influenced by angles measured on radiographs. Angles of interest are the hallux valgus angle (HVA), 1,2-intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), as well as the presence of first metatarsophalangeal joint (MTPJ) subluxation. Guidelines for measuring those angles have been distributed by American Orthopaedic Foot and Ankle Society (AOFAS), although the influence of weightbearing on these angles and its clinical relevance is not clear. We conducted a study to determine the influence of weightbearing and the inter- and intraobserver agreement in the measurement. A total of 104 patients were enrolled in this study. Both weightbearing and non-weightbearing radiographs were obtained. In 2 rounds, 2 orthopedic surgeons and 2 musculoskeletal radiologists measured the angles in blinded digital radiographs according to AOFAS guidelines. Agreement on measurement of HVA, IMA, and DMAA in both weightbearing and non-weightbearing radiographs, as well as the presence of MTPJ subluxation, was calculated using the linear-weighted kappa coefficient and the intraclass correlation coefficient (ICC). Examiner agreement strength was defined according to the guidelines of Landis and Koch. HVA decreases significantly with weightbearing, whereas IMA significantly increases. The change in magnitude was 1° to 2° on average. No significant influence on DMAA could be noted. Interobserver agreement was excellent in both weightbearing and non-weightbearing radiographs for HVA (ICC 0.99 and ICC 0.99, respectively), IMA (ICC 0.98 and ICC 0.86, respectively), and DMAA (ICC 0.95 and ICC 0.97, respectively). The agreement on presence of subluxation was moderate to good (Fleiss kappa 0.50 to 0.63). Weightbearing alters forefoot geometry significantly. Adhering to AOFAS guidelines yields excellent interobserver agreement on HVA, IMA, and DMAA. First MTPJ subluxation presence is not an alternative for DMAA. The magnitude of change in IMA and HVA is small and therefore not clinically important. Both weightbearing and non-weightbearing radiographs can be used for determination of the correct treatment of hallux valgus deformity.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Journal of Foot and Ankle Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Hallux valgus.J Bone Joint Surg Am. 1996; 78: 932-966
- Prevalence of hallux valgus in the general population: a systematic review and meta-analysis.J Foot Ankle Res. 2010; 3: 21
- Current concepts review: hallux valgus part II: operative treatment.Foot Ankle Int. 2007; 28: 748-758
- Current concepts review: hallux valgus part 1: pathomechanics, clinical assessment, and nonoperative management.Foot Ankle Int. 2007; 28: 654-659
- Angular measurements in the evaluation of hallux valgus deformities: a report of the ad hoc committee of the American Orthopaedic Foot and Ankle Society on angular measurements.Foot Ankle Int. 2002; 23: 68-74
- Hallux valgus: demographics, etiology, and radiographic assessment.Foot Ankle Int. 2007; 28: 759-777
- Comparison between manual and computer-assisted measurements of hallux valgus parameters.Foot Ankle Int. 2004; 25: 708-711
- Goniometric versus computerized angle measurement in assessing hallux valgus.Foot Ankle Int. 2005; 26234238
- Radiographic angles in hallux valgus: differences between measurements made manually and with a computerized program.Foot Ankle Int. 2006; 27: 175-180
- Radiographic angles in hallux valgus: comparison between manual and computer-assisted measurements.J Foot Ankle Surg. 2010; 49: 523-528
- Validity and reliability of hallux valgus angle measured on digital photographs.J Orthop Sports Phys Ther. 2012; 42: 642-648
- Roger A. Mann Award. The reliability of angular measurements in hallux valgus deformities.Foot Ankle Int. 2001; 22: 369-379
- Validity and reliability of the first distal metatarsal articular angle.Foot Ankle Int. 1994; 15: 541-547
- Intra- and inter-observer reliability of the distal metatarsal articular angle in adult hallux valgus.Foot Ankle Int. 2002; 23: 722-726
- Comparison of radiographic and anatomic distal metatarsal articular angle in cadaver feet.Foot Ankle Int. 2014; 35: 389-393
- Do weight-bearing films affect decision making in hallux valgus surgery?.J Foot Ankle Surg. 2012; 51: 293-295
- Reliability and relationship of radiographic measurements in hallux valgus.Clin Orthop Relat Res. 2012; 470: 2613-2621
- Radiographic changes in forefoot geometry with weightbearing.Foot Ankle Int. 2003; 24: 326-331
- Radiographic analysis of hallux valgus in women on weightbearing and nonweightbearing.Clin Orthop Relat Res. 1997; 336: 186-194
- Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 1: hallux valgus.J Foot Ankle Surg. 2003; 42: 112-123
- Scarf osteotomy for hallux valgus deformity: an intermediate followup of clinical and radiographic outcomes.Foot Ankle Int. 2006; 27: 883-886
- Hallux valgus angle as main predictor for correction of hallux valgus.BMC Musculoskelet Disord. 2008; 9: 70
- Intraclass correlations: uses in assessing rater reliability.Psychol Bull. 1979; 86: 420-428
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- The biomechanics of the first metatarsal bone in hallux valgus: a preliminary study utilizing a weight bearing extremity CT.Foot Ankle Surg. 2013; 19: 155-161
- Radiographic correlates of hallux valgus severity in older people.J Foot Ankle Res. 2010; 3: 20
- Hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint.J Bone Joint Surg Am. 1998; 80: 898-908
Financial Disclosure: This study was funded with a research grant from the Haaglanden Medical Center.
Conflict of Interest: None reported.
© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.