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The Controversial Definition of Normal Toe Alignment

“Normal” and “abnormal” are frequently used in surgical planning and to evaluate surgical results of the forefoot. However, there is no objectifiable value of metatarsophalangeal angles (MTPAs) 2–5 in the dorsoplantar (DP) view with which to objectively evaluate lesser toe alignment. We aimed to det...

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Autores principales: Schippers, Philipp, Drees, Philipp, Gercek, Erol, Wunderlich, Felix, Müller, Daniel, Ruckes, Christian, Meyer, Alexander, Klein, Stefan, Fischer, Sebastian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10218812/
https://www.ncbi.nlm.nih.gov/pubmed/37240615
http://dx.doi.org/10.3390/jcm12103509
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author Schippers, Philipp
Drees, Philipp
Gercek, Erol
Wunderlich, Felix
Müller, Daniel
Ruckes, Christian
Meyer, Alexander
Klein, Stefan
Fischer, Sebastian
author_facet Schippers, Philipp
Drees, Philipp
Gercek, Erol
Wunderlich, Felix
Müller, Daniel
Ruckes, Christian
Meyer, Alexander
Klein, Stefan
Fischer, Sebastian
author_sort Schippers, Philipp
collection PubMed
description “Normal” and “abnormal” are frequently used in surgical planning and to evaluate surgical results of the forefoot. However, there is no objectifiable value of metatarsophalangeal angles (MTPAs) 2–5 in the dorsoplantar (DP) view with which to objectively evaluate lesser toe alignment. We aimed to determine which angles are considered to be “normal” by orthopedic surgeons and radiologists. Thirty anonymized radiographs of feet were submitted twice in randomized order to determine the respective MTPAs 2–5. After six weeks, the anonymized radiographs and photographs of the same feet without apparent affiliation were presented again. The terms “normal,” “borderline normal,” and “abnormal” were assigned by the observers. Viewers considered MTP-2 alignment from 0° to −20° to be normal, and below −30° abnormal; MTP-3, 0° to −15° to be normal and below −30° abnormal; MTP-4, 0° to −10° normal and below −20° abnormal. Between 5° valgus and 15° varus was the range of MTP-5 recognized as normal. High intra-observer but low interobserver reliability with overall low correlation of clinical and radiographic aspects was observed. The assessment of the terms “normal” or “abnormal” are subject to a high degree of variation. Therefore, these terms should be used cautiously.
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spelling pubmed-102188122023-05-27 The Controversial Definition of Normal Toe Alignment Schippers, Philipp Drees, Philipp Gercek, Erol Wunderlich, Felix Müller, Daniel Ruckes, Christian Meyer, Alexander Klein, Stefan Fischer, Sebastian J Clin Med Article “Normal” and “abnormal” are frequently used in surgical planning and to evaluate surgical results of the forefoot. However, there is no objectifiable value of metatarsophalangeal angles (MTPAs) 2–5 in the dorsoplantar (DP) view with which to objectively evaluate lesser toe alignment. We aimed to determine which angles are considered to be “normal” by orthopedic surgeons and radiologists. Thirty anonymized radiographs of feet were submitted twice in randomized order to determine the respective MTPAs 2–5. After six weeks, the anonymized radiographs and photographs of the same feet without apparent affiliation were presented again. The terms “normal,” “borderline normal,” and “abnormal” were assigned by the observers. Viewers considered MTP-2 alignment from 0° to −20° to be normal, and below −30° abnormal; MTP-3, 0° to −15° to be normal and below −30° abnormal; MTP-4, 0° to −10° normal and below −20° abnormal. Between 5° valgus and 15° varus was the range of MTP-5 recognized as normal. High intra-observer but low interobserver reliability with overall low correlation of clinical and radiographic aspects was observed. The assessment of the terms “normal” or “abnormal” are subject to a high degree of variation. Therefore, these terms should be used cautiously. MDPI 2023-05-17 /pmc/articles/PMC10218812/ /pubmed/37240615 http://dx.doi.org/10.3390/jcm12103509 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Schippers, Philipp
Drees, Philipp
Gercek, Erol
Wunderlich, Felix
Müller, Daniel
Ruckes, Christian
Meyer, Alexander
Klein, Stefan
Fischer, Sebastian
The Controversial Definition of Normal Toe Alignment
title The Controversial Definition of Normal Toe Alignment
title_full The Controversial Definition of Normal Toe Alignment
title_fullStr The Controversial Definition of Normal Toe Alignment
title_full_unstemmed The Controversial Definition of Normal Toe Alignment
title_short The Controversial Definition of Normal Toe Alignment
title_sort controversial definition of normal toe alignment
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10218812/
https://www.ncbi.nlm.nih.gov/pubmed/37240615
http://dx.doi.org/10.3390/jcm12103509
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