Radiographic Severity and Symptom Severity in Hallux Valgus

NewsBot · Apr 24, 2019

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Correlation of Preoperative Radiographic Severity With Disability and Symptom Severity in Hallux Valgus.
Matthews M et al
Foot Ankle Int. 2019 Apr 22

BACKGROUND:
Some US insurance companies have recently started to require minimum angular measurements, for coverage decisions, in patients seeking operative correction for symptomatic hallux valgus. This logic naturally assumes that the magnitude of radiographic bunion deformity is related to the magnitude of patient's presenting symptoms and/or disability.

METHODS:
We conducted an analysis of existing data in our practice to determine whether patient-reported symptoms and disability prior to bunion surgery correlated with preoperative radiographic measurements commonly used to quantify hallux valgus severity. Symptoms and disability level were determined using patient-reported preoperative Foot and Ankle Outcome Score (FAOS), a validated instrument commonly used in hallux valgus assessment. Spearman correlation coefficient was then used to quantify the strength of any correlations. Preoperative data from 107 patients (107 feet) with mean age of 49.3 ± 13.8 years who underwent isolated osseous hallux valgus surgery within our practice between June 1, 2016, and July 30, 2018, were available.

RESULTS:
No radiographic variable achieved even a moderate correlation with any of the FAOS subscales with the exception of tibial sesamoid position with FAOS Pain (rho=0.402, P = .01) in patients aged 56 years and older. The direction of this correlation was positive, indicating that greater preoperative sesamoid abnormalities were paradoxically associated with less presenting pain (ie, higher FAOS Pain scores).

CONCLUSION:
It would appear that radiographic severity of bunion deformity is not well correlated with symptom level and/or disability and, we would argue, should not play a role in coverage decisions for patients presenting for hallux valgus surgery.
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NewsBot · Oct 29, 2019

Can radiology reflect patient satisfaction after hallux valgus surgery?
Baca E, Tuy E, Çelen KM.
Eklem Hastalik Cerrahisi. 2019 Dec;30(3):241-5

OBJECTIVES:
This study aims to define the first web space length (FWSL) as a new radiologic parameter, which may reflect patients' subjective satisfaction and be associated with American Orthopedic Foot and Ankle Society (AOFAS) score as an objective parameter.

PATIENTS AND METHODS:
One hundred and fourteen patients (11 males, 103 females; mean age 43.4±13.2 years; range, 18 to 70 years) who underwent distal osteotomy between April 2010 and January 2018 were retrospectively reviewed. Patients were radiographically evaluated with pre- and postoperative standing foot anteroposterior and lateral X-rays. Hallux valgus angles (HVAs), intermetatarsal angle (IMA), and FWSL were measured. AOFAS scores were used for clinical evaluation. Satisfaction scores were obtained using a visual analog scale at the final follow-up.

RESULTS:
The relationship between postoperative AOFAS score changes and postoperative HVA changes was statistically significant (p=0.001, p<0.1). The relationship between postoperative AOFAS values and postoperative FWSL changes was statistically significant (p<0.001, p<0.1). No statistically significant relationship was detected between postoperative AOFAS values and IMA changes (p=0.101, p>0.05). The relationship between AOFAS scores and satisfaction scale was statistically significant (r=0.695; p<0.001, p<0.01). The relationship between the satisfaction scale and FWSL was statistically significant (p=0.005, p<0.01).

CONCLUSION:
The FWSL has an influence on patient satisfaction. It is correlated both with AOFAS scores and satisfaction scale. It can be used as a measurable parameter to detect patient satisfaction.
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NewsBot · Dec 9, 2021

Radiographic validation of a self-report instrument for hallux valgus
Vatsal Gupta et al
Musculoskeletal Care. 2021 Dec 3.

Background: Hallux valgus (HV) is a common condition causing substantial morbidity. Radiographic assessment is the gold standard for grading severity but is not always feasible in clinical/research settings. HV line-drawings, consisting of five drawings for each foot depicting a sequential increase in HV angle of 15°, have been clinically validated for self-reporting severity. We aimed to undertake radiographic validation of this self-report instrument.

Methods: Adults aged ≥50 from four GP practices were sent a health survey. Responders self-reported HV severity for each foot using the line-drawing instrument. Those reporting foot pain in the last year had radiographs taken at a research clinic from which intermetatarsal, hallux abductus and hallux interphalangeal abductus angles were calculated. Ten feet were randomly selected for each HV line-drawing grade for both feet. Associations between self-reported HV line drawings and radiographic measurements were assessed using Spearman's ρ correlation coefficients, mean radiographic angle measurement (95% confidence interval) and one-way analysis of variance.

Results: Increasing HV line-drawing grade was positively correlated with radiographic measurements for intermetatarsal and hallux abductus angles (Spearman's ρ = 0.602, p < 0.001; 0.821, p < 0.001, respectively). Hallux interphalangeal abductus angle showed an inverse correlation with increasing line-drawing grade (-0.204, p = 0.053). Differences in radiographic measures between HV line drawing grades were significant for intermetatarsal (F = 13.98, p < 0.001) hallux abductus (F = 38.90, p < 0.001) but not hallux interphalangeal abductus angle (F = 2.21, p = 0.075).

Conclusion: Grading HV severity by self-reported HV line-drawings provides a valid representation of deformity determined from radiographic measurements and is a useful screening/self-reporting tool.
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NewsBot · Aug 30, 2022

Identification of radiographic characteristics associated with pain in hallux valgus patients: A preliminary machine learning study
ChenGuang Wang et al
Front Public Health. 2022 Aug 10

Objective: To investigate the association between the structural deformity and foot pain in hallux valgus (HV) patients using a multi-variate pattern analysis (MVPA) approach.

Methods: Plain radiographic metrics were calculated from 36 painful and 36 pain-free HV feet. In analysis 1, univariate analyses were performed to investigate the clinical and radiographic differences between painful and pain-free HV. In analysis 2, we investigated the pattern differences for radiographic metrics between these two groups using a MVPA approach utilizing a support vector machine. In analysis 3, sequential backward selection and exhaustive search were performed as a feature-selection procedure to identify an optimal feature subtype. In analysis 4, hierarchical clustering analysis was used to identify the optimal radiographic HV subtype associated with pain in HV.

Results: We found that: (1) relative to feet with pain-free HV, the painful ones exhibited a higher hallux valgus angle, i.e., the magnitude of distal metatarsal and phalangeal deviation; (2) painful HV could be accurately differentiated from pain-free HV via MVPA. Using sequential backward selection and exhaustive search, a 5-feature subset was identified with optimal performance for classifying HV as either painful or pain-free; and (3) by applying hierarchical clustering analysis, a radiographic subtype with an 80% pain incidence was identified.

Conclusion: The pain in HV is multifactorial and associated with a radiographic pattern measured by various angles on plain radiographs. The combination of hallux valgus angle, inter-phalangeal angle, distal metatarsal articular angle, metatarsal cuneiform angle and metatarsal protrusion distance showed the optimal classification performance between painful and pain-free HV.
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NewsBot · Apr 3, 2023

The Distal Metatarsal Articular Angle in Hallux Valgus Deformities. Comparisons of Radiographic and Weightbearing CT Scan Measurements with Variations in Hindfoot Position
Jill S. Kawalec, Porscha Dort, Trenton Leo, Lawrence S. Osher, Rocco Petrozzi
The Foot; 29 March 2023, 102030

Highlights
•A novel approach and reliable method for measuring DMAA in hallux valgus deformity.
•Weightbearing CT is not subject to geometric distortions & positional foot variations.
•Weightbearing CT is less likely to overestimate DMAA than plain radiographic imaging.
•Weightbearing CT serves as a reference standard for DMAA assessment.
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Background
When evaluating hallux valgus (HV) deformity with anteroposterior (AP) foot radiographs, the distal metatarsal articular angle (DMAA) has been the subject of frequent debate. Although a straightforward indicator of structural alignment of the distal first metatarsal articular surface, inter- and intraobserver measurements can vary widely. Alterations in the radiographic appearance of bony “structure” with positional changes of the foot/foot bones in HV deformities in no small part contributes to these inaccuracies. The aim of this study was to determine the effect of hindfoot position on the DMAA.

Methods
Four different radiologic images were obtained for 15 subjects with HV: three AP foot radiographs (standard weightbearing, foot supinated, foot pronated) and one weightbearing CT (WBCT) scan. For each image, five investigators measured the DMAA in order to assess reliability.

Results
Mean DMAA values measured from the images indicated that the angle was highest with the pronated foot (15.3 (95% CI, 10.3-20.3) degrees) and lowest when measured from the CT image (11.6 (95% CI, 7.3-16.0) degrees). For all image types, the intraclass correlation coefficient was greater than 0.9 and statistically significant (P < 0.0005).

Conclusion
Hindfoot positions affected radiographic DMAA/mean DMAA values, with values highest with feet in pronated attitudes. Unlike radiographic projections, the WBCT appears less likely to overestimate DMAA and is not subject to variations in foot positioning. In the preoperative evaluation of HV deformities, this points to the potential use of WBCT as a reference standard. For markedly severe HV deformities that may present with AP radiographs with marked first metatarsal head “roundness,” the use of WBCT is the intuitive choice.

The results indicate excellent reliability in measurements of DMAA between all five investigators. As such, the measurement method used to determine DMAA in this study was dependable and reproducible
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NewsBot · May 4, 2023

The distal metatarsal articular angle in hallux valgus deformities. Comparisons of radiographic and weightbearing CT scan measurements with variations in hindfoot position
Jill S Kawalec et al
Foot (Edinb). 2023 Mar 29

Background: When evaluating hallux valgus (HV) deformity with anteroposterior (AP) foot radiographs, the distal metatarsal articular angle (DMAA) has been the subject of frequent debate. Although a straightforward indicator of structural alignment of the distal first metatarsal articular surface, inter- and intraobserver measurements can vary widely. Alterations in the radiographic appearance of bony "structure" with positional changes of the foot/foot bones in HV deformities in no small part contributes to these inaccuracies. The aim of this study was to determine the effect of hindfoot position on the DMAA.

Methods: Four different radiologic images were obtained for 15 subjects with HV: three AP foot radiographs (standard weightbearing, foot supinated, foot pronated) and one weightbearing CT (WBCT) scan. For each image, five investigators measured the DMAA in order to assess reliability.

Results: Mean DMAA values measured from the images indicated that the angle was highest with the pronated foot (15.3 (95% CI, 10.3-20.3) degrees) and lowest when measured from the CT image (11.6 (95% CI, 7.3-16.0) degrees). For all image types, the intraclass correlation coefficient was greater than 0.9 and statistically significant (P < 0.0005).

Conclusion: Hindfoot positions affected radiographic DMAA/mean DMAA values, with values highest with feet in pronated attitudes. Unlike radiographic projections, the WBCT appears less likely to overestimate DMAA and is not subject to variations in foot positioning. In the preoperative evaluation of HV deformities, this points to the potential use of WBCT as a reference standard. For markedly severe HV deformities that may present with AP radiographs with marked first metatarsal head "roundness," the use of WBCT is the intuitive choice. The results indicate excellent reliability in measurements of DMAA between all five investigators. As such, the measurement method used to determine DMAA in this study was dependable and reproducible.
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