4/30/2023 0 Comments Bunion xrayThis way the dataset of 38 pairs of WB and NWB x-rays was collected. Each foot was imaged separately with beam aimed at the second metatarsocuneiform joint. All patients had weightbearing (WB) x-ray of the foot which was performed with the film placed in a horizontal position and patient standing with weight distributed between both feet. The exclusion criteria covered the following: previous surgery or signs of bony trauma at the foot, inadequate quality of non-weightbearing imaging. As the NWB x-rays were brought from outside locations, their positioning was unstandardized. The patients were included if they presented with symptomatic hallux valgus (diagnosis M20.1) and had non-weightbearing (NWB) x-rays performed no longer than 6 months prior to presentation of symptomatic foot available. This is non-interventional study and formal consent was not required.Ī set of 25 consecutive patients (38 feet) presenting between 20 were prospectively included in the study (demographic data in Table 1). The study was performed as a single-center retrospective case-control analysis of x-ray dataset. The working hypothesis was that although the measured parameters would differ, the clinical decisions would remain unchanged. In this study, we aimed to investigate (first) the influence of weightbearing status on radiological hallux valgus parameters and (second) on clinical decisions based on these radiographs. The results of available literature on significance of weightbearing imaging for clinical decision making are, however, contradictory, with some researchers reporting important influence and others no influence of weightbearing on final surgical decisions. Majority of studies agree that radiological parameters of hallux valgus differ if measured in weightbearing and non-weightbearing imaging. The repeated imaging, causing repeated radiation, is justified only if it is expected to benefit the patient’s treatment. Basing decision on non-weightbearing imaging may negatively influence the outcome, but repeating the imaging requires additional radiation. In the case of the patient presenting with non-weightbearing x-rays, the surgeon is presented with a dilemma. While the standard imaging is well established, it is sometimes not followed in clinical practice, where primary imaging is ordered in community clinics. The standard imaging for a patient presenting with a symptomatic hallux valgus is weightbearing foot x-ray. Repeating radiographs is justified in patients presenting with NWB radiographs of symptomatic HV. NWB films overestimate early and underestimate advanced HV deformity. ConclusionsĬlinical decisions based on WB and NWB radiographs vary significantly. In only 45% of cases, the decisions based on NWB and WB imaging were consistent (kappa (95% CI) = 30.0 (23.7–36.3)). Clinical decisions for 10 x-ray pairs were studied among 40 respondents. In the dataset of WB and NWB x-rays, the hallux valgus (HVA) and intermetatarsal angle (IMA) were measured and differences analyzed. In this study, the influence of WB status on radiological HV parameters and on clinical decisions was analyzed. Repeated imaging requires additional radiation, justified only if expected to benefit patient’s treatment. In our clinical practice, often patients are presenting with non-weightbearing (NWB) x-rays. Weightbearing (WB) x-ray is standard imaging for symptomatic hallux valgus (HV). To report the effect of weightbearing x-ray imaging on clinical decisions in hallux valgus.
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