Hallux Valgus Evaluation on MRI: Can Measurements Validated on Radiographs Be Used?

Abstract

Hallux valgus (HV) is a common deformity of the great toe affecting >23% of adults in the United States. The severity of the deformity is traditionally analyzed using radiographs to determine measurements such as the HV and intermetatarsal angles. We sought to determine the relationship between the radiographic and magnetic resonance imaging (MRI) measurements because this is not yet known. Two of us analyzed a series of 56 consecutive patients who had had radiographs and MRI performed on the same foot between April 27, 2015 and March 9, 2016 and who satisfied all other inclusion and exclusion criteria (age 18 to 100 years, no history of recent foot trauma, and no metal hardware in the foot). We found excellent interreader reliability (intraclass correlation 0.89 to 0.96) and intermodality agreement (intraclass correlation 0.83 to 0.91). The HV angle measured 15.0° ± 8.8° on the MRI scans and 13.8° ± 8.7° on the radiographs (mean difference -1.15° ± 3.89°), and the intermetatarsal angle was 9.0° ± 3.1° on the MRI scans and 8.8° ± 2.9° on the radiographs (mean difference -0.22° ± 2.10°). The HV measurements were reliable on both radiographs and MRI for the range of values tested. Small intermodality statistically significant differences in HV angle measurements were found; however, these might not be enough to be clinically significant.

Keywords: bunion; hallux valgus angle; intermetatarsal angle; magnetic resonance image; radiograph.