Inter-observer and intra-observer reliability in the radiographic measurements of paediatric forefoot alignment

Barbara Jasiewicz; Jacek Pietraszek; Sławomir Duda; Szymon Pietrzak; Błażej Pruszczyński; Tomasz Parol; Tomasz Potaczek; Aneta Gądek-Moszczak

doi:10.1016/j.fas.2020.04.015

Inter-observer and intra-observer reliability in the radiographic measurements of paediatric forefoot alignment

Foot Ankle Surg. 2021 Jun;27(4):371-376. doi: 10.1016/j.fas.2020.04.015. Epub 2020 May 12.

Authors

Barbara Jasiewicz¹, Jacek Pietraszek², Sławomir Duda³, Szymon Pietrzak⁴, Błażej Pruszczyński⁵, Tomasz Parol⁶, Tomasz Potaczek⁷, Aneta Gądek-Moszczak⁸

Affiliations

¹ Jagiellonian University, Faculty of Medicine, Department of Orthopaedics and Rehabilitation, Balzera 15, 34-500 Zakopane, Poland. Electronic address: basiajasiewicz@gmail.com.
² Cracow University of Technology, Faculty of Mechanical Engineering, Institute of Applied Informatics, al. Jana Pawla II 37, 31-864 Krakow, Poland. Electronic address: jacek.pietraszek@mech.pk.edu.pl.
³ Jagiellonian University, Faculty of Medicine, Department of Orthopaedics and Rehabilitation, Balzera 15, 34-500 Zakopane, Poland. Electronic address: slawomir.duda@gmail.com.
⁴ Department of Orthopaedics, Paediatric Orthopaedics and Traumatology, Centre of Postgraduate Medical Education in Warsaw, Gruca Orthopaedic Hospital, Ks. Stanislawa Konarskiego 13, 05-400 Otwock, Poland. Electronic address: szymon-pietrzak@o2.pl.
⁵ Department of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, 251 Pomorska str, 92-213 Lodz, Poland. Electronic address: bpruszcz@pruszczynski.com.pl.
⁶ Department of Orthopaedics, Paediatric Orthopaedics and Traumatology, Centre of Postgraduate Medical Education in Warsaw, Gruca Orthopaedic Hospital, Ks. Stanislawa Konarskiego 13, 05-400 Otwock, Poland. Electronic address: tparol@gmail.com.
⁷ Jagiellonian University, Faculty of Medicine, Department of Orthopaedics and Rehabilitation, Balzera 15, 34-500 Zakopane, Poland. Electronic address: tomaszpotaczek@gmail.com.
⁸ Cracow University of Technology, Faculty of Mechanical Engineering, Institute of Applied Informatics, al. Jana Pawla II 37, 31-864 Krakow, Poland. Electronic address: aneta.moszczak@gmail.com.

PMID: 32456981
DOI: 10.1016/j.fas.2020.04.015

Abstract

Background: Foot bones in children have more rounded shapes in radiograms than adults. Thus, the goal of this work was assessing inter- and intra-observer reliability in paediatric forefoot angle measurements.

Material and methods: Six forefoot angles in 34 AP standing paediatric foot radiographs were measured by 5 researchers. A classic statistical analysis with use of IBM SPSS Statistics 25 was performed and a new method with two-way analysis of variance was applied.

Results: Results of statistical analysis revealed the properties of a subjective assessment related to specific angles. Kilmartin's angle, calcaneus-fifth metatarsal angle and first ray angle are the most reliable; metatarsus adductus angle should be used with great caution in pediatric population. Engel's angle is the most difficult for measuring and measurement error is the highest.

Conclusion: The power of paediatric forefoot measurements is various. Several angles are reliable, while Engle's angle is the most doubtful.

Keywords: Foot radiographs; Paediatric foot; Reliability.

MeSH terms

Adolescent
Child
Child, Preschool
Female
Flatfoot / diagnostic imaging*
Foot / diagnostic imaging*
Foot Bones / diagnostic imaging*
Humans
Male
Metatarsus Varus / diagnostic imaging*
Observer Variation*
Radiography / methods
Reproducibility of Results
Retrospective Studies
Standing Position