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Reliability and Validity of Radiographic Measurements in Hindfoot Varus and Valgus

Lee, Kyoung Min MD; Chung, Chin Youb MD; Park, Moon Seok MD; Lee, Sang Hyeong MD; Cho, Jae Hwan MD; Choi, In Ho MD

Journal of Bone & Joint Surgery - American Volume: 6 October 2010 - Volume 92 - Issue 13 - p 2319–2327
doi: 10.2106/JBJS.I.01150
Scientific Articles
Supplementary Content

Background: Clinical decision-making in the treatment of foot deformities is based primarily on the results of the physical examination and the radiographic findings. The purpose of this study was to determine the validity and reliability of commonly used radiographic measurements of hindfoot valgus and varus deformities.

Methods: Seventy-two patients with hindfoot deformity (thirty-six hindfoot valgus, mean age 15.5 years; thirty-six hindfoot varus, mean age 30.2 years) were evaluated. Nine representative indices on weight-bearing radiographs were assessed. Three examiners measured the radiographic indices at two sessions, and intraobserver and interobserver reliability was determined. Discriminant validity of the radiographic measurements between hindfoot valgus and varus was evaluated. The correlation with pedobarographic findings in evaluating the distribution of foot pressure during gait was assessed for convergent validity.

Results: Naviculocuboid overlap, anteroposterior talonavicular coverage angle, anteroposterior talus-first metatarsal angle, calcaneal pitch angle, and lateral talus-first metatarsal angle showed excellent reliability. Naviculocuboid overlap, anteroposterior talonavicular coverage angle, and anteroposterior talus-first metatarsal angle showed excellent discriminant validity (in terms of effect-size r) and convergent validity (in terms of correlation coefficients with pedobarography).

Conclusions: Naviculocuboid overlap, anteroposterior talonavicular coverage angle, and anteroposterior talus-first metatarsal angle are reliable and valid measures for the evaluation of hindfoot valgus and varus deformities.

Level of Evidence: Diagnostic Level III. See Instructions to Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Sungnam, Kyungki 463-707, South Korea. E-mail address for M.S. Park: pmsmed@gmail.com

2Department of Orthopaedic Surgery, Seoul National University Children’s Hospital, 28 Yeongon-Dong, Jongno-Gu, Seoul 110-744, South Korea

Copyright 2010 by The Journal of Bone and Joint Surgery, Incorporated
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