ABSTRACT
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.
Keywords
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References
- 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
Article info
Footnotes
Financial Disclosure: This study was funded with a research grant from the Haaglanden Medical Center.
Conflict of Interest: None reported.
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