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To investigate the reliability and concurrent validity of photographic measurements of hallux valgus angle compared to radiographs as the criterion standard.
Clinical assessment of hallux valgus involves measuring alignment between the first toe and metatarsal on weight-bearing radiographs or grading the severity of deformity visually using categorical scales. Digital photographs offer a non-invasive method of measuring deformity on an exact scale; however, the validity of this technique has not previously been established.
Thirty-eight subjects (30 female, 8 male) were examined (76 feet; 54 with hallux valgus). Computer software was used to measure hallux valgus angle from digital records of bilateral weight-bearing dorsoplantar foot radiographs and photographs. One examiner measured 76 feet on 2 occasions 2 weeks apart, and a second examiner measured 40 feet on a single occasion. Reliability was investigated by intraclass correlation coefficients (ICCs) and validity by 95% limits of agreement (LA). Pearson's correlation coefficient was also calculated.
Intrarater and interrater reliability were very high (ICCs > 0.96) and 95% LA between photographic and radiographic measurements were acceptable. Measurements from photographs and radiographs were also highly correlated (Pearson's r = 0.96).
Digital photographic measurements of hallux valgus angle are reliable and have acceptable validity compared to weight-bearing radiographs. This method provides a convenient and precise tool in assessment of hallux valgus, while avoiding the cost and radiation exposure associated with x-rays