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Radiologic analysis of hindfoot alignment: Comparison of Méary, long axial, and hindfoot alignment views
T Neri1, R Barthelemy2, Y Tourné3
1Department of orthopaedic surgery, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne, France; Inter-university laboratory of human movement science, EA 7424, université de Lyon, UJM-Saint-Étienne, 42023 Saint-Étienne, France.
Background:
Among radiographic views available for assessing hindfoot alignment, the antero-posterior weight-bearing view with metal cerclage of the hindfoot (Méary view) is the most widely used in France. Internationally, the long axial view (LAV) and hindfoot alignment view (HAV) are used also. The objective of this study was to compare the reliability of these three views.
Hypothesis:
The Méary view with cerclage of the hindfoot is as reliable as the LAV and HAV for assessing hindfoot alignment.
Material And Methods:
All three views were obtained in each of 22 prospectively included patients. Intra-observer and inter-observer reliabilities were assessed by having two observers collect the radiographic measurements then computing the intra-class correlation coefficients (ICCs).
Results:
The intra-observer and inter-observer ICCs were 0.956 and 0.988 with the Méary view, 0.990 and 0.765 with the HAV, and 0.997 and 0.991 with the LAV, respectively. Correlations were far stronger between the LAV and HAV than between each of these and the Méary view. Compared to the LAV and HAV, the Méary view indicated a greater degree of hindfoot valgus.
Discussion:
Intra-observer reliability was excellent with both the LAV and HAV, whereas inter-observer reliability was better with the LAV. Excellent reliability was also obtained with the Méary view. Combining the Méary view to obtain a radiographic image of the clinical deformity with the LAV to measure the angular deviation of the hindfoot axis may be useful when assessing hindfoot malalignment. A comparison of the three views in a larger population is needed before clinical recommendations can be made.
Level Of Evidence:
II, prospective study.
