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Scientific Articles   |    
Reliability and Validity of Radiographic Measurements in Hindfoot Varus and Valgus
Kyoung Min Lee, MD1; Chin Youb Chung, MD1; Moon Seok Park, MD1; Sang Hyeong Lee, MD1; Jae Hwan Cho, MD1; In Ho Choi, MD2
1 Department 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
2 Department of Orthopaedic Surgery, Seoul National University Children's Hospital, 28 Yeongon-Dong, Jongno-Gu, Seoul 110-744, South Korea
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Sungnam, and the Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul, South Korea

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Oct 06;92(13):2319-2327. doi: 10.2106/JBJS.I.01150
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Abstract

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.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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