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Backgrounds <p>Pediatric foot deformities disrupt biomechanics and can lead to long-term musculoskeletal complications. Radiographic parameters, particularly the anteroposterior talo–1st metatarsal angle (AP talo–1MT), are widely used; however, their accuracy may be compromised in the presence of hallux valgus. The clinical utility of the anteroposterior talo–2nd metatarsal angle (AP talo–2MT) has not been well established. This study evaluated radiographic parameters by correlating them with pedobarographic indices, hypothesizing that AP talo–2MT would demonstrate comparable or superior functional associations to AP talo–1MT.</p> Methods <p>We retrospectively reviewed 64 pediatric patients with hindfoot varus (<i>n</i> = 32) or valgus (<i>n</i> = 32) deformities who underwent weight-bearing radiographs and pedobarographic testing between 2017 and 2024. Radiographic variables included AP talo–1MT, AP talo–2MT, talonavicular coverage, hallux valgus angle, intermetatarsal angle, lateral talo–1MT, calcaneal pitch, and naviculocuboid overlap. Pedobarographic outcomes comprised surface area, mean pressure, and pressure-time integral across forefoot, midfoot, and hindfoot regions. Interobserver reliability was assessed using intraclass correlation coefficients (ICCs). Group differences were analyzed with t-tests and effect sizes, and age-adjusted partial correlations were calculated to evaluate associations.</p> Results <p>All radiographic parameters demonstrated excellent reliability (ICC 0.872–0.996). Significant differences were observed in AP talo–1MT, AP talo–2MT, lateral talo–1MT, and naviculocuboid overlap between hindfoot varus and valgus groups (all <i>p</i> &lt; 0.001). Pedobarographic analysis revealed distinct loading patterns, especially in midfoot and lateral regions. Both AP talo–1MT and AP talo–2MT correlated with total foot surface area and midfoot loading indices; AP talo–2MT demonstrated comparable associations and larger discriminative effect sizes between hindfoot varus and valgus.</p> Conclusion <p>AP talo–2MT demonstrated excellent reliability and showed comparable functional associations to AP talo–1MT. It may be a useful complementary radiographic parameter for evaluating pediatric foot deformities, but further validation in broader cohorts and predefined subgroups is needed.</p> Level of Evidence <p>Level III, retrospective cross-sectional study.</p>

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Clinical validity of radiographic parameters for evaluating pediatric foot deformities: correlation with pedobarographic analysis

  • 期刊论文

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  • 发表日期：

    2026年3月26日

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  • Woo Sub Kim,
  • Gyu Hwan Lee,
  • Min Sub Kim,
  • Ki Hyuk Sung

摘要

Backgrounds

Pediatric foot deformities disrupt biomechanics and can lead to long-term musculoskeletal complications. Radiographic parameters, particularly the anteroposterior talo–1st metatarsal angle (AP talo–1MT), are widely used; however, their accuracy may be compromised in the presence of hallux valgus. The clinical utility of the anteroposterior talo–2nd metatarsal angle (AP talo–2MT) has not been well established. This study evaluated radiographic parameters by correlating them with pedobarographic indices, hypothesizing that AP talo–2MT would demonstrate comparable or superior functional associations to AP talo–1MT.

Methods

We retrospectively reviewed 64 pediatric patients with hindfoot varus (n = 32) or valgus (n = 32) deformities who underwent weight-bearing radiographs and pedobarographic testing between 2017 and 2024. Radiographic variables included AP talo–1MT, AP talo–2MT, talonavicular coverage, hallux valgus angle, intermetatarsal angle, lateral talo–1MT, calcaneal pitch, and naviculocuboid overlap. Pedobarographic outcomes comprised surface area, mean pressure, and pressure-time integral across forefoot, midfoot, and hindfoot regions. Interobserver reliability was assessed using intraclass correlation coefficients (ICCs). Group differences were analyzed with t-tests and effect sizes, and age-adjusted partial correlations were calculated to evaluate associations.

Results

All radiographic parameters demonstrated excellent reliability (ICC 0.872–0.996). Significant differences were observed in AP talo–1MT, AP talo–2MT, lateral talo–1MT, and naviculocuboid overlap between hindfoot varus and valgus groups (all p < 0.001). Pedobarographic analysis revealed distinct loading patterns, especially in midfoot and lateral regions. Both AP talo–1MT and AP talo–2MT correlated with total foot surface area and midfoot loading indices; AP talo–2MT demonstrated comparable associations and larger discriminative effect sizes between hindfoot varus and valgus.

Conclusion

AP talo–2MT demonstrated excellent reliability and showed comparable functional associations to AP talo–1MT. It may be a useful complementary radiographic parameter for evaluating pediatric foot deformities, but further validation in broader cohorts and predefined subgroups is needed.

Level of Evidence

Level III, retrospective cross-sectional study.