High Variability of Observed Weight Bearing During Standing Foot and Ankle Radiographs

Background: Weight-bearing radiographs are a critical component of evaluating foot and ankle pathology. An underlying assumption is that patients are placing 50% of their body weight on the affected foot during image acquisition. The accuracy of weight bearing during radiographs is unknown and, presumably, variable, which may result in uncertain ability of the resultant radiographs to appropriately portray the pathology of interest. Methods: Fifty subjects were tested. The percentage body weight through the foot of interest was measured at the moment of radiographic image acquisition. The subject was then instructed to bear “half [their] weight” prior to the next radiograph. The percentage body weight was calculated and compared to ideal 50% weight bearing. Results: The mean percentage body weight in trial 1 and 2 was 45.7% ± 3.2% (P = .012 compared to the 50% mark) and 49.2% ± 2.4%, respectively (P = .428 compared to 50%). The mean absolute difference in percentage weight bearing compared to 50% in trials 1 and 2 was 9.3% ± 2.3% and 5.8% ± 1.8%, respectively (P = .005). For trial 1, 18/50 subjects were within the “ideal” (45%-55%) range for weight bearing compared to 32/50 on trial 2 (P = .005). In trial 1, 24/50 subjects had “appropriate” (>45%) weight bearing compared to 39/50 on trial 2 (P = .002). Conclusions: There was substantial variability in the weight applied during radiograph acquisition. This study raises questions regarding the assumptions, reliability, and interpretation when evaluating weight-bearing radiographs. Level of Evidence: Level III, comparative study.