Bland–Altman Analysis of Different Radiographic Measurements of the Hallux Valgus Angle and the Intermetatarsal Angle After Distal Osteotomy

Abstract

The aim of the present study was to evaluate commonly used approaches for detection of radiographic angles in hallux valgus deformity patients. Methods: This retrospective study was conducted in patients with hallux valgus deformity at Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2016 to January 2019. The inclusion criteria were: (i) postoperative dorsoplantar weight-bearing radiographs for the feet of patients with the hallux valgus; (ii) patients had been managed with a distal osteotomy of the first metatarsal and the osteotomized bone ends recovered. The exclusion criteria applied were as follows: (i) age > 65 years or < 18 years old; (ii) blurry image; (iii) previous history of severe foot trauma and surgery. Postoperative radiographs for hallux valgus were analyzed using six methods: by a line drawn through the long axis of the first metatarsal bone (method 1); an extended line drawn to bisect the shaft of the metatarsal at two levels with joined points of bisection (method 2); a line drawn to connect the center of the articular surface of the metatarsal head and the center of the proximal articulation (method 3); a line drawn from the center of the head of the first metatarsal head through the center of the base of the first metatarsal bone (method 4); a line drawn through the center of the head and the center of the proximal shaft (method 5); and a line drawn from the center of the head of the first metatarsal head through the center of the proximal articulation (method 6). The measurement results obtained were subjected to Bland-Altman analysis and consistency evaluation. Results: A total number of 20 radiographs were collected for measurement. No statistically significant differences were found in the measurement values among the six methods (P > 0.05). The lowest values of the average measurement, standard deviation, and confidence interval were established in method 3, followed by those in methods 1 and 4. The standard deviation of the measurement value and the confidence interval in method 2 were the largest. Methods 1 and 4 had similar confidence intervals and were with a high consistency. Due to the nature of the retrospective study, no follow-up and complications were applicable in the present study. Conclusion: Line drawn through the long axis of the first metatarsal bone (method 1) and line drawn from the center of the head of the first metatarsal head through the center of the base of the first metatarsal bone (method 4) were reliable and well repeatable, and may be used for postoperative radiographs.

The Linear Hallux Valgus Offset– A novel way to measure Hallux Valgus

“…A normal value is under 9 . 22,23 The IMA, like the HVA, can similarly be affected by the measurement method and subjected to potential risk in error. However, studies have shown no improvement in reliability based on experience.…”

Comparing human milk macronutrients measured using analyzers based on mid-infrared spectroscopy and ultrasound and the application of machine learning in data fitting

“…If the difference follows a normal distribution, 95% of the points should be within the mean ± 1.96 SD. This interval is called the 95% LOA [44][45][46].…”

Clinical effectiveness of distal metatarsophalangeal mini-invasive osteotomy on hallux valgus

“…We intend to analyze the imaging changes and symptom scores of hallux valgus patients before and 12 months after operation, and comprehensively evaluate the clinical e cacy of DMMO in the treatment of hallux valgus.The imaging evaluation is to take the weight-bearing X-ray positive and lateral view of the foot, and measure and analyze the changes of HVA, IMA and DASA before and 12 months after the operation on the X-ray lm.The imaging angle measurement in this research refers to the paper by DAI [9] .The symptom function score included comparing the VAS score of patients before and after operation and evaluating the overall curative effect according to AOFAS score scale: 90-100 points were excellent, 75-89 points were good, 50-74 points were fair, 50 points were poor [10] . This clinical trial has been registered in China Clinical Trial Registration Center, registration number (ChiCTR2000038668).…”