The Controversial Definition of Normal Toe Alignment.

Area of Science:

• Orthopedics
• Radiology
• Podiatry

Background:

• Surgical planning and outcome evaluation in forefoot surgery often rely on subjective definitions of "normal" and "abnormal."
• Objective criteria for assessing lesser toe alignment using metatarsophalangeal angles (MTPAs) in the dorsoplantar (DP) view are lacking.

Purpose of the Study:

• To determine the range of metatarsophalangeal angles (MTPAs) 2-5 considered "normal" by orthopedic surgeons and radiologists.
• To assess the reliability of subjective interpretations of lesser toe alignment.

Main Methods:

• Thirty anonymized foot radiographs were reviewed twice by orthopedic surgeons and radiologists.
• Observers assigned terms like "normal," "borderline normal," and "abnormal" to specific MTPAs (2-5).
• Intra-observer and interobserver reliability were analyzed.

Main Results:

• Established subjective ranges for "normal" MTPAs: MTP-2 (0° to -20°), MTP-3 (0° to -15°), MTP-4 (0° to -10°), and MTP-5 (5° valgus to 15° varus).
• Found high intra-observer reliability but low interobserver reliability.
• Observed a low correlation between clinical and radiographic assessments.

Conclusions:

• The assessment of "normal" or "abnormal" lesser toe alignment based on MTPAs is highly variable among specialists.
• The terms "normal" and "abnormal" should be used cautiously in surgical planning and evaluation due to subjective interpretation.
• Further research may be needed to establish objective, reliable radiographic parameters for lesser toe alignment.