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Manual and Visual Assessment of Foot Type and Posture Correlate Poorly With Radiographic Assessment: A
Steve Bayer1,2, Elizabeth Plakseychuk1,2, Kenzo Cotton1,2
1Biodynamics Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Foot & Ankle Orthopaedics
|April 24, 2026
Summary
Manual and visual foot assessments show poor agreement with radiographic methods. Nonradiographic techniques, including photographs, struggle to consistently classify foot types, highlighting the impact of methodology on diagnosis.
Area of Science:
- Orthopedics
- Podiatry
- Biomechanical analysis
Background:
- Foot type classification is crucial for diagnosing and managing musculoskeletal conditions.
- Radiographic assessment is considered a gold standard, but nonradiographic methods are more accessible.
Purpose of the Study:
- To evaluate the agreement between manual, visual, and radiographic assessments of foot type.
- To compare the interrater reliability of quantitative versus qualitative foot assessment measures.
Main Methods:
- 92 participants underwent bilateral foot photography, radiography, and physical examination.
- Five reviewers assessed various foot parameters including Radiographic Arch Type, calcaneal pitch, Meary angle, Arch Index, and Foot Posture Index.
- Statistical analysis included correlations, interrater reliability (intraclass correlation coefficient), and sensitivity/specificity using calcaneal pitch as the reference.
Main Results:
- Photographic and radiographic measures demonstrated moderate to good interrater reliability (ICC 0.52-0.83).
- However, agreement between different assessment methods was poor (kappa < 0.40).
- Radiographic Arch Type showed the highest sensitivity and specificity for classifying foot types; photographs were best for identifying normal feet.
Conclusions:
- Foot type classification is highly dependent on the chosen methodology and classification criteria.
- Nonradiographic methods, including visual and photographic assessments, do not consistently classify foot type compared to radiographic standards like calcaneal pitch and Meary angle.
