Measuring Hallux Valgus: A Comparison of Conventional Radiography and Clinical Parameters with Regard to Measurement Accuracy

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Abstract
To assess the repeatability and error of conventional x-ray measurements, intra- and interobserver evaluations of measurement accuracy were done on 20 preoperative and 40 postoperative (20 chevron and 20 proximal osteotomy) x-rays of hallux valgus patients. Standard x-rays showed an average interobserver error of measurement of 6.4° for the hallux valgus angle, 5.4° for the intermetatarsal angle, and 2.0 mm for the intermetatarsal distance. The intraobserver error did not differ greatly. The repeatability and error of two clinical measurements, ball circumference, and dorsal to plantar range of motion of the first metatarsophalangeal joint were evaluated for 20 healthy volunteers. The ball circumference had an average measurement error of 1.1 cm, whereas the dorsal and plantar range of motion of the great toe had an average measurement error of 12° in dorsiflexion and 16° in plantarflexion. In both clinical and radiographic parameters, linear measurements were more accurate than angular measurements. Although x-rays are of value in hallux valgus surgery, standard x-rays are less accurate than previously assumed. Small changes produced by osteotomies may be hidden by the postoperative measurement error. The results of hallux valgus surgery should primarily be evaluated clinically. When clinical and radiological evaluations are made, linear measurements may be preferable.