Sesamoid View Weightbearing Radiography vs Weightbearing Computed Tomography in the Measurement of Metatarsal Pronation Angle

Background: First metatarsal pronation angle (MPA) is increasingly relevant in the management of hallux valgus and is assessed on weightbearing computed tomography (WBCT) and sesamoid-view weightbearing radiography (WBR). The purpose of this study is to compare MPA measured by WBCT against WBR to determine if any systematic discrepancy in MPA measurement exists between the 2 modalities. Methods: A total of 40 patients with 55 feet were included for study. MPA was measured in all patients by 2 independent readers on both WBCT and WBR with an appropriate washout period between measurement modalities. Mean MPA by WBCT and WBR were analyzed; interobserver reliability was calculated with an intraclass correlation coefficient (ICC) value. Results: Mean MPA as measured by WBCT was 3.7 ± 7.9 degrees (95% CI, 1.6-5.9; range −11.7 to 20.5). Mean MPA measured on WBR was 3.6 ± 8.4 degrees, (95% CI, 1.4-5.8; range −12.6 to 21.4). There was no difference in MPA as measured by WBCT compared to WBR (P = .529). Interobserver reliability was excellent with an ICC of 0.994 for WBCT and 0.986 for WBR. Conclusion: Measurement of first MPA by WBCT and WBR was not significantly different. In our cohort of patients with and without forefoot pathology, we found that either sesamoid view weightbearing radiographs or weightbearing CT can be used reliably to measure first MPA and will generate similar values. Level of Evidence: Level IV, case series.