SLR - December 2009 - Jeffrey Schnell
Reference:
Shima, H., Okuda, R., Yasuda. T., Jotoku, T., Kitano, N., Kinoshita, M. (2009). Radiographic measurements in patients with hallux valgus before and after proximal crescentic osteotomy. The Journal of Bone and Joint Surgery (American), 91, 1369-76.
Scientific Literature Review
Reviewed by: Jeffrey Schnell, DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
This study compares five different methods of measuring radiographic hallux valgus angles before and after proximal crescentic osteotomies, and determining the most reliable technique.
Methods:
Twenty patients undergoing proximal crescentic osteotomy with a distal soft tissue procedure had pre and postoperative dorsoplantar weight bearing radiographs. Exclusion criteria included variables such as previous foot surgery, additional foot procedures, and patients with rheumatoid arthritis or hallux rigidus. Five methods of measurement were illustrated,explained, and independently measured by three surgeons. Analysis of variance was used to compare mean pre and post-op values with a set p < 0.05 level of significance using the Tukey test.
Results:
Significant differences were discovered among the five different methods of measuring the hallux valgus angle. The greatest variation and statistical significance was found when the location of the distal reference point was on or near the osteotomy compared to the articular surface.. The greatest reliability was found when the reference point was located in the center of the first metatarsal head and the center of the proximal articular surface of the first metatarsal, method E in the study.
Conclusions:
The investigators recommend that when evaluating the pre and post-operative measurements of a proximal crescentic osteotomy for correction of hallux valgus,using a line created by the center of the first metatarsal head and the center of the proximal articular surface yields the greatest reliability when calculating the hallux valgus angle.