Podoscopic classification of second toe deformities.

Area of Science:

• Orthopedics
• Podiatry
• Surgical Classification Systems

Background:

• The French Association of Foot Surgery (AFCP) classification is a recent visual method for assessing sagittal plane deformities of the second toe.
• Dynamic assessment tools are needed to complement existing static classifications.

Purpose of the Study:

• Introduce and evaluate the Toe-Ground Area Score (TAS) as a dynamic assessment tool for second toe deformities.
• Determine if TAS can classify all types of second toe deformities.
• Assess the intra- and inter-observer reliability of TAS.
• Evaluate the learning curve associated with TAS.

Main Methods:

• A retrospective study involving 52 second toes evaluated using a podoscope.
• Ten foot and ankle surgeons independently assessed standardized, blinded videos of each case.
• Assessments were repeated three times, 15 days apart, to calculate intra- and inter-observer reliability (ICC and Fleiss' Kappa).
• Mean assessment time was recorded.

Main Results:

• The TAS successfully rated all 522 observations across 10 surgeons.
• Intra-observer reliability ranged from substantial (ICC: 0.79) to excellent (ICC: 0.88).
• Inter-observer reliability was substantial (Kappa: 0.76) to excellent (Kappa: 0.81).
• Mean assessment time was 22 ± 11 seconds per case in later rounds.

Conclusions:

• The Toe-Ground Area Score (TAS) is a reliable and quick method for assessing second toe deformities.
• TAS provides valuable dynamic information on the toe's ability to engage the ground when used with static classifications like AFCP.