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The Reliability of Common Radiographic Measurements Used to Describe Foot Deformities.

Mohammad Junayed Khan1, Modupe D Apetuje2, Eugene Cheng3

  • 1Neighborhood Health Center (FQHC), Buffalo, NY; Penn Presbyterian Medical Center, Philadelphia, PA.

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons
|September 10, 2023
PubMed
Summary

Standard radiographic measurements for foot deformities show poor agreement between surgeons (inter-rater reliability) but good consistency within individual surgeons (intrarater reliability). This raises concerns about their routine clinical use.

Keywords:
foot deformityhallux valgusmetatarsaltoevalidityx-ray image

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Biostatistics

Background:

  • Radiographic measurements are essential for classifying foot deformities and guiding treatment decisions.
  • The reliability of these measurements is crucial for their validity and clinical utility.
  • Inter-rater and intra-rater reliability assess the consistency of measurements between different observers and by the same observer over time, respectively.

Purpose of the Study:

  • To evaluate the inter- and intra-rater reliability of standard radiographic measurements used for foot deformity classification.
  • To assess the generalizability of these measurements across multiple surgeons.

Main Methods:

  • Correlation coefficients were calculated to assess reliability.
  • Fifty-two sets of foot radiographs were independently assessed by five experienced raters.
  • Rater instructions were standardized to published protocols for 12 forefoot and 12 rearfoot measurements.

Main Results:

  • A significant lack of inter-rater reliability was observed (correlation coefficients <0.4) for most common radiographic measurements.
  • Strong intra-rater reliability was demonstrated (correlation coefficients >0.6), indicating consistency within individual raters.
  • The findings suggest variability in how different surgeons interpret and apply standard radiographic measurements.

Conclusions:

  • The weak inter-rater reliability of common radiographic foot measurements challenges their routine use in categorizing deformity, selecting treatments, and evaluating surgical outcomes.
  • The validity of these measurements is compromised by the lack of agreement between surgeons.
  • Improved standardization and rigorous practice of radiographic measurement techniques may be necessary to enhance their clinical utility.