Artificial intelligence-based diagnosis of hallux valgus interphalangeus using anteroposterior foot radiographs

A recently developed method enables automated measurement of the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA) from weight-bearing foot radiographs. This approach employs bone segmentation to identify anatomical landmarks and provides standardized angle measurements based on established guidelines. While effective for HVA and IMA, preoperative radiograph analysis remains complex and requires additional measurements, such as the hallux interphalangeal angle (IPA), which has received limited research attention.

To expand the previous method, which measured HVA and IMA, by incorporating the automatic measurement of IPA, evaluating its accuracy and clinical relevance.

A preexisting database of manually labeled foot radiographs was used to train a U-Net neural network for segmenting bones and identifying landmarks necessary for IPA measurement. Of the 265 radiographs in the dataset, 161 were selected for training and 20 for validation. The U-Net neural network achieves a high mean Sørensen-Dice index (> 0.97). The remaining 84 radiographs were used to assess the reliability of automated IPA measurements against those taken manually by two orthopedic surgeons (O_A and O_B) using computer-based tools. Each measurement was repeated to assess intraobserver (O_A1 and O_A2) and interobserver (O_A2 and O_B) reliability. Agreement between automated and manual methods was evaluated using the Intraclass Correlation Coefficient (ICC), and Bland-Altman analysis identified systematic differences. Standard error of measurement (SEM) and Pearson correlation coefficients quantified precision and linearity, and measurement times were recorded to evaluate efficiency.

The artificial intelligence (AI)-based system demonstrated excellent reliability, with ICC3.1 values of 0.92 (AI vs O_A2) and 0.88 (AI vs O_B), both statistically significant (P < 0.001). For manual measurements, ICC values were 0.95 (O_A2 vs O_A1) and 0.95 (O_A2 vs O_B), supporting both intraobserver and interobserver reliability. Bland-Altman analysis revealed minimal biases of: (1) 1.61° (AI vs O_A2); and (2) 2.54° (AI vs O_B), with clinically acceptable limits of agreement. The AI system also showed high precision, as evidenced by low SEM values: (1) 1.22° (O_A2 vs O_B); (2) 1.77° (AI vs O_A2); and (3) 2.09° (AI vs O_B). Furthermore, Pearson correlation coefficients confirmed strong linear relationships between automated and manual measurements, with r = 0.85 (AI vs O_A2) and r = 0.90 (AI vs O_B). The AI method significantly improved efficiency, completing all 84 measurements 8 times faster than manual methods, reducing the time required from an average 36 minutes to just 4.5 minutes.

The proposed AI-assisted IPA measurement method shows strong clinical potential, effectively corresponding with manual measurements. Integrating IPA with HVA and IMA assessments provides a comprehensive tool for automated forefoot deformity analysis, supporting hallux valgus severity classification and preoperative planning, while offering substantial time savings in high-volume clinical settings.