Grading hallux valgus

Hylton Menz · May 19, 2005

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Radiographic validation of the Manchester scale for the classification of hallux valgus deformity

H. B. Menz and S. E. Munteanu

Objectives. Hallux valgus is a common orthopaedic condition affecting elderly people. Grading the severity of the condition commonly involves obtaining measurements from radiographs, which may not be feasible or necessary in some clinical or research settings. Recently, a non-invasive clinical assessment tool (the Manchester scale), consisting of four standardized photographs, has been developed; however, its validity has not yet been determined. Therefore, the objective of this study was to determine the validity of this tool by correlating Manchester scale scores with hallux valgus measurements obtained from radiographs. Methods. Weight-bearing dorsoplantar foot radiographs were obtained from 95 subjects (31 men and 64 women) aged 62-94 yr (mean 78.6, s.d. 6.5), and measurements of the hallux abductus angle, intermetatarsal angle and hallux interphalangeal adbuctus angle were performed. These measurements were then correlated with the Manchester scale scores (none, mild, moderate or severe). Results. The Manchester scale score was highly correlated with hallux abductus angle (Spearman's = 0.73, P<0.01) and moderately associated with intermetatarsal angle ( = 0.49, P<0.01) measurements obtained from radiographs. Analysis of variance revealed significant differences in mean hallux abductus angles [F(3) = 119.99, P<0.001] and intermetatarsal angles [F(3) =29.56, P<0.001] between the four Manchester scale categories. Conclusions. These findings indicate that the Manchester scale provides a valid representation of the degree of hallux valgus deformity determined from radiographic measurement of hallux abductus angle and intermetatarsal angle. We therefore recommend the use of this instrument as a simple, non-invasive screening tool for clinical and research purposes.

http://rheumatology.oupjournals.org/cgi/content/abstract/keh687v1

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Hylton

NewsBot · Sep 10, 2015

Correlation between Manchester Grading Scale and American Orthopedic Foot and Ankle Society Score in Patients with Hallux Valgus.
Iliou K, Paraskevas G, Kanavaros P, Barbuti A, Vrettakos A, Gekas C, Kitsoulis P
International Journal of the Kuwait University, Health Science Centre [2015]

OBJECTIVE:
To evaluate the correlation between Manchester grading scale and the American Orthopedic Foot and Ankle Society [AOFAS] preoperative score in patients with hallux valgus deformity.
Materials (Subjects) and Methods<br>The study sample included 181 feet of 122 patients with hallux valgus and 424 feet of 212 individuals without hallux valgus deformity as a control group. The severity of hallux valgus using the Manchester grading scale and the AOFAS score was determined on all individuals in the hallux valgus and the control group. Pearson correlation and the non parametric test Kruskal Wallis and Mann-Whitney were used for data analysis.
Results: <br>The AOFAS total score in participants with no deformity was 99.14. In patients with mild or moderate deformity the total score was 86.20 and 68.19 respectively. In severe hallux valgus the total score has been found to be 44.69. Statistically significant differences between the four grades of Manchester grading scale were present for the AOFAS total score (p=0.000) . In Pearson correlation, strong negative correlations were found between the AOFAS score and hallux valgus angle ( r = -0.899, p=0.000). Strong negative correlations were demonstrated between the AOFAS score and the first intermetatatarsal angle as well (r = -0.748, p=0.000)
Conclusion:<br>High negative correlation between Manchester grading scale and AOFAS score was observed, as the severity of hallux valgus is increased, the AOFAS score seemed to decrease. <br>.
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NewsBot · Apr 25, 2021

Using Manchester Scale Classification of Hallux Valgus as a Valuable Tool in Determining Appropriate Risk Categorization during Initial Diabetic Foot Screening in Primary Health Care Settings
SulejmanMenzildzic et al
The Foot; 19 April 2021, 101810

Highlights
•Identifying foot deformity severity is part of assessing risk for diabetic foot.
•Pressure distribution/amount correlates to Manchester scale Hallux valgus deformity.
•Critical pressure threshold crossed only for severe stage Hallux valgus deformity.
•Manchester scale can be used in primary care risk assessment of diabetic patients.
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Limitations have been identified in the current state of primary care practises with regards to identifying and correctly categorizing foot deformity and its associated risk of developing foot ulcers in patients with diabetes. This study aims to bridge these gaps through the implementation of additional categorization tools to be made available for primary care professionals. This study thus analysed the relationship between foot pressure distribution and amount in patients with diabetes with Hallux Valgus foot deformity, and its different stages, in order to better understand the clinical applications of the Manchester Scale. Statistically significant data in pressure distribution (P < 0.05) was found in all three severity groups identified by the Manchester Scale (Mild, Moderate and Severe) when compared to a No deformity group. However, only the Severe Hallux Valgus group crossed the threshold over 500 kPa in the area of first metatarsal bone. Further research should aim to analyse pressure distribution and amount in patients with both diabetes and diabetic neuropathy of all stages of Hallux Valgus.
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NewsBot · May 16, 2023

Development of Hallux Valgus Classification Using Digital Foot Images with Machine Learning
Mitsumasa Hida et al
Life 2023, 13(5),

Hallux valgus, a frequently seen foot deformity, requires early detection to prevent it from becoming more severe. It is a medical economic problem, so a means of quickly distinguishing it would be helpful. We designed and investigated the accuracy of an early version of a tool for screening hallux valgus using machine learning. The tool would ascertain whether patients had hallux valgus by analyzing pictures of their feet. In this study, 507 images of feet were used for machine learning. Image preprocessing was conducted using the comparatively simple pattern A (rescaling, angle adjustment, and trimming) and slightly more complicated pattern B (same, plus vertical flip, binary formatting, and edge emphasis). This study used the VGG16 convolutional neural network. Pattern B machine learning was more accurate than pattern A. In our early model, Pattern A achieved 0.62 for accuracy, 0.56 for precision, 0.94 for recall, and 0.71 for F1 score. As for Pattern B, the scores were 0.79, 0.77, 0.96, and 0.86, respectively. Machine learning was sufficiently accurate to distinguish foot images between feet with hallux valgus and normal feet. With further refinement, this tool could be used for the easy screening of hallux valgus.
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NewsBot · Jul 20, 2023

Classification of Hallux Valgus Using Conjugated Deformity
Nenad Stojanović et al
Journal of Applied Mathematics and Physics > Vol.11 No.6, June 2023

Hallux valgus is a complex deformity of the forefoot. It is the result of multiple effects of endogenous and exogenous etiological factors with different degrees of influence. The degree of hallux valgus deformity was assessed by radiological values of hallux valgus (HVA) and intermetatarsal (IMA) angle. Thus, each hallux valgus deformity corresponds to a pair (HVA, IMA) of hallux valgus angle (HVA) and intermetatarsal angle (IMA) values in the plane of the deformity. The intensity of the point position vector S (HVA, IMA) in the deformation plane determined by the relation represents the absolute (conjugate) value of the power deformities. The goal of the article is to explain the advantage of the definition of the degree of hallux valgus deformity using its absolute (conjugate) value, and then to show that the degree of deformity defined in this way enables a better classification of deformities for all values of the HVA and IMA angles. Furthermore, in this article, applying the definition of conjugate deformity, analytical expressions were constructed for the assessment of the average value of deformity correction after operative treatment, as well as the error assessment of deformity correction after operative treatment. All obtained results were checked on a sample of 396 operatively treated feet.
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NewsBot · Dec 31, 2023

The Triplanar Hallux Abducto Valgus Classification System: Is it Valid?
Alexander Padovano, MD et al
December 14, 2023

Historically, two-dimensional radiographic study techniques have been used to classify deformity and guide treatment of hallux valgus deformities in the transverse plane. Recently, a triplanar hallux abducto valgus classification system was proposed. The key elements of this classification system are the pathologic alignments in three anatomic planes. The triplanar hallux abducto valgus classification system is intended to clarify the deformity and apply a triplanar anatomic algorithm for treatment. To our knowledge, this classification system has not been validated. Our objective was to assess reliability of the triplanar hallux valgus classification system.
Patients with hallux abducto valgus were identified from a foot and ankle registry. Digital radiographs were assembled in a digital slide presentation. The eligibility criteria required complete radiographic studies and represented varying degrees of hallux abducto valgus. The reviewers included three board certified, fellowship trained orthopaedic foot and ankle surgeons. Each reviewer independently classified the hallux abducto valgus deformity for a total of 75 observations. After an eight-week washout period, the order of the hallux abducto valgus cases was randomized in the digital slide presentation and redistributed to the reviewers.
The average kappa value from three readers was 0.241 with 95% CI (0.093-0.374), indicating a fair agreement. The inter-reader agreement was 0.046 with 95% CI (-0.041-0.112), showing poor agreement between readers.
Our results indicate the triplanar hallux abducto valgus is not a reliable classification system. While this is the first known triplanar hallux abducto valgus classification system, it lacks prognostic value and reliability.
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