This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the exam for this article:
 Foot/Ankle Test 2: Treatment of Inflammation and Deformity
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Schneider, W.
Right arrow Articles by Knahr, K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schneider, W.
Right arrow Articles by Knahr, K.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American) 85:494-499 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Reproducibility of the Radiographic Metatarsophalangeal Angle in Hallux Surgery

Wolfgang Schneider, MD, Robert Csepan, MD and Karl Knahr, MD

Investigation performed at the Orthopaedic Hospital Vienna-Speising, Vienna, Austria

Wolfgang Schneider, MD
Robert Csepan, MD
Karl Knahr, MD
Second General Orthopaedic Department, Orthopaedic Hospital Vienna-Speising, Speisingerstrasse 109, A-1130 Vienna, Austria. E-mail address for W. Schneider: wsmail{at}ping.at

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Five different methods have been described to define the longitudinal axis of the first metatarsal for radiographic measurements of the first metatarsophalangeal angle. None of these methods has been validated for both preoperative and postoperative assessment of patients undergoing hallux valgus surgery. Previous studies have demonstrated conflicting results regarding the measurement accuracy of these methods.

Methods: To evaluate the measurement accuracy of these five methods, we calculated the intraobserver and interobserver coefficients of repeatability for all five methods with use of twenty preoperative and twenty postoperative standardized plain dorsoplantar weight-bearing radiographs of patients undergoing chevron distal osteotomy.

Results: The preoperative assessment of the metatarsophalangeal angle revealed small differences among the five methods. The intraobserver coefficient of repeatability ranged from 2.10° to 3.34°, and the interobserver coefficient ranged from 2.17° to 3.44°. The postoperative assessment demonstrated substantial differences between methods in which the diaphysis of the first metatarsal is used as a reference (intraobserver coefficient, 5.06° to 7.23°; interobserver coefficient, 5.29° to 8.19°) and methods in which there is one reference point in the metatarsal head and one reference point in the base of the first metatarsal (intraobserver coefficient, 1.88° to 2.67°; interobserver coefficient, 1.86° to 2.34°).

Conclusions: For the assessment of patients undergoing a distal metatarsal osteotomy, we cannot recommend methods in which the metatarsal shaft is used as a reference for the axis of the first metatarsal. Such methods had poor measurement accuracy, especially postoperatively. Methods with reference points distal and proximal to any possible osteotomy site had much better measurement reproducibility. We recommend the method described by Miller in 1974, in which a line is drawn from the center of the first metatarsal head through the center of the base of the first metatarsal, as it was the most precise method and was least biased by postoperative effects.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
R. Okuda, M. Kinoshita, T. Yasuda, T. Jotoku, N. Kitano, and H. Shima
The Shape of the Lateral Edge of the First Metatarsal Head as a Risk Factor for Recurrence of Hallux Valgus
J. Bone Joint Surg. Am., October 1, 2007; 89(10): 2163 - 2172.
[Abstract] [Full Text] [PDF]