A Method for Measurement of the Hypertrophic First Metatarsal Medial Eminence on Foot Radiographs—A Reliability Study with Surgical Implications


Background: It has been suggested that hypertrophic eminence on the medial head of the first metatarsal is a component of the patho-anatomy of hallux valgus. However, research findings in this area are inconsistent, possibly due to differences in methods in identifying and measuring the medial eminence. To date, reliability of any method of measurement has not been reported. The purpose of this study was to determine the reliability of measurement of the medial eminence on medial oblique and dorsoplantar radiographs using a previously described geometric technique. Methods: To evaluate the reliability of a method of measurement of the medial eminence of the first metatarsal duplicate standardized dorsoplantar and medial oblique radiographs were taken of one foot of 15 subjects. The feet included both rectus feet and subjects with hallux valgus. The medial eminence was measured on the digital images using Inteleviewer 2.5 (Intelerad medical systems incorporated, Montreal, Quebec) software. Observer 1 measured one randomly selected image from each subject to determine inter-observer reliability. Observer 2 measured all images to determine the overall intraobserver reliability. Reliability was calculated using intra-class correlation coefficients (ICC). Results: The mean projection of the medial eminence ranged from 0.39 to 0.44 cm in both views. The ICCs were calculated for the dorsoplantar view and the 2 medial oblique view measures between observers. They ranged from 0.76 intra-rater and 0.86 interrater in the dorsoplantar view to 0.80 intra-rater and 0.90 inter-rater in the medial oblique view indicating good reliability in all measures. The average of the 4 oblique views also showed a high level of reliability with a coefficient of 0.96. Conclusions: The medial eminence can be reliably measured in the medial oblique and dorsoplantar view using the described technique. The medial oblique and the dorsoplantar views are valuable and reliable projections for visualising the dorso medial aspect of the first metatarsal.

Share and Cite:

Armanasco, P. , Briffa, K. and Pang, N. (2014) A Method for Measurement of the Hypertrophic First Metatarsal Medial Eminence on Foot Radiographs—A Reliability Study with Surgical Implications. Journal of Analytical Sciences, Methods and Instrumentation, 4, 31-37. doi: 10.4236/jasmi.2014.41005.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Schweitzer, M.A., Maheshwarie, S. and Shabshin, N. (1999) Hallux Valgus and Hallux Rigidus: MRI Findings. Clinical Imaging, 23, 397-402. http://dx.doi.org/10.1016/S0899-7071(00)00167-4
[2] Thordarson, D.B. and Krewer, P. (2002) Medial Eminence Thickness with and without Hallux Valgus. Foot and Ankle International, 23, 48-50.
[3] Mann, R. and Coughlin, M.J. (1994) Adult Hallux Valgus. In: Mann, R. and Coughlin, M.J., Eds., Surgery of the Foot and Ankle (6th Edition), St. Louis, Mosby, 175.
[4] Resch, S., Ryd, L., Strenstrom, A., Johnsson, K. and Kristbjorn, R. (1995) Measuring Hallux Valgus: A Comparison of Conventional Radiography and Clinical Parameters with Regard to Measurement Accuracy. Foot and Ankle International, 16, 267-270. http://dx.doi.org/10.1177/107110079501600504
[5] Bryant, J. (2001) A Comparison of Radiographic Foot Measurements Taken in Two Different Positions. Journal of the Podiatric Medical Association, 81, 234-238.
[6] Christman, R.A. and Ly, P. (1990) Radiographic Anatomy of the First Metatarsal. Journal of the Podiatric Medical Association, 90, 177-203.
[7] Martin, D. and Pontious, J. (2001) Introduction and Evaluation of Hallux Abducto Valgus. In: Banks, A.S., Downey, M.S., Martin, D.E., Miller. McGlarmry’s Comprehensive Textbook of Foot and Ankle Surgery, Vol 1 (3rd Edition), Lippincott Williams and Wilkins, 484.
[8] Brand, P.W. and Coleman, W.C. (1984) A Standard for Dorsal Plantar and Lateral Radiographic Projections of the Feet. Orthopedics, 10, 117-120.
[9] Panchbhavi, V.K. and Trevino, S. (2004) Comparison between Manual and Computer-Assisted Measurements of Hallux Valgus Parameters. Foot and Ankle International, 25, 708-711.
[10] Bryant, A., Tinley, P. and Singer, K. (2000) A Comparison of Radiographic Measurements in Normal, Hallux Valgus, and Hallux Limitus Feet. The Journal of Foot and Ankle Surgery, 39, 39-43.
[11] Ballinger, P.W. (1999) Merrill’s Atlas of Radiographic Positions and Radiologic Procedures. 9th Edition, St Louis, Mosby, 177.
[12] Portney, L.G. and Watkins, M.P. (1993) Interpretation of the Intraclass Coefficients. In: Foundations of Clinical Research Applications to Practice: Appleton & Lange, 199, 513-514.
[13] May, S., Littlewood, C. and Bishop, A. (2006) Reliability of Procedures in the Physical Examination of Non-Specific Low Back Pain: A Systematic Review. Australian Journal of Physiotherapy, 52, 91-102.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.