Validity and Reliability of a New Radiological Method to Estimate Medial Column Internal Rotation in Hallux Valgus Using Foot Weight-Bearing X-Ray

Abstract

Background Medial column internal rotation in hallux valgus (HV) can be measured using weight-bearing computed tomography (WBCT). Anteroposterior weight-bearing foot radiographs’ (WBXR) ability to estimate medial column internal rotation in HV was evaluated comparing these measurements with those obtained from WBCT. Methods Three observers evaluated WBCT and WBXR of 33 HV feet twice. Medial column internal rotation was measured with WBCT and classified into 3 levels according to WBXR findings. Intra- and interobserver reliability were obtained for WBXR and WBCT, in addition to WBXR-WBCT correlation. Results WBXR and WBCT intraobserver agreement was substantial and near perfect, respectively (κ 0.79 and 0.84). Their interobserver agreement was excellent (intraclass correlation 0.85 and 0.9, respectively). The WBXR-WBCT correlation was substantial (κ 0.68). WBXR diagnostic accuracy to predict the WBCT results was 85%. Conclusions The proposed method for medial column internal rotation measurement using WBXR is reliable and has a substantial agreement with WBCT measurements. Levels of Evidence Level III

Third Generation Rotational Percutaneous Osteotomy to Hallux Valgus

“…Level 3 represents more than 30 degrees with the lateral head contour resembling a round circle. 20 (3) Nonelderly patient under 60 years of age. Older patients with long-standing deformities usually have significant soft tissue retraction that would make a percutaneous triplane correction of the metatarsal head difficult.…”

“…The fact that weight-bearing changes pronation makes the intraoperative assessment of pronation unreliable. 20,21 For this reason, the preoperative quantitative analysis of rotation is essential. It can be performed by WBXR or, if available, WBCT.…”

“…The WBXR should be performed with the beam angled at 15 degrees from anterior to posterior, centered at the midfoot. The severity is classified according to the levels 0, 1, 2, and 3 as validated by Wagner et al 20 The sesamoid displacement is also evaluated and classified in seven stages according to the tibial sesamoid position as described by Hardy and Clapham. 22 The rotational component can also be evaluated by WBCT through the alpha angle described by Kim et al 2 In addition to the preoperative analysis of rotation, the control of the intraoperative correction is also very important.…”

“…This is defined as a HV angle >20 degrees and/or the intermetatarsal angle between the first and second rays >12 degrees. Rotational component of at least 10 degrees. It can be evaluated by an anteroposterior weight-bearing radiographs (WBXR) using the lateral shape of the metatarsal head described by Okuda et al19 or by weight-bearing computed tomography (WBCT) through the alpha angle described by Kim et al2 The lateral shape of the metatarsal head validated by Wagner et al20 analyses the rotational component into 0 to 3 levels, depending on the roundness of the lateral aspect of the metatarsal head. Level 0 represents 0 to 10 degrees of rotation with the first lateral contour of the metatarsal head flat.…”

Biomechanical Cadaveric Evaluation of the Role of Medial Column Instability in Hallux Valgus Deformity

“…Medial column instability is a frequent finding in patients with flatfeet, hyperlaxity, hallux valgus, and long-standing valgus deformity of the foot and ankle. 3,7,13,15,20,22 Even though it is a widely accepted concept and recognized component in different pathologies, there is no clear explanation, description, and/or understanding of its etiology and consequences on the foot.…”