Reliability and validity of measures of hammer toe deformity angle and tibial torsion

Abstract 

Background

Measures of second–fourth metatarsophalangeal joint (MTPJ) angle (indicator of hammer toe deformity) and clinical measures of tibial torsion have limited evidence for validity and reliability. The purposes of this study are to determine: (1) reliability of using a 3D digitizer (Metrecom) and computed tomography (CT) to measure MTPJ angle for toes 2–4; (2) reliability of goniometer, 3D digitizer, and CT to measure tibial torsion; (3) validity of MTPJ angle measures for toes 2–4 using goniometry and 3D digitizer compared to CT (gold standard) and (4) validity of tibial torsion measures using goniometry and 3D digitizer (Metrecom) compared to CT (gold standard).

Methods

Twenty-nine subjects participated in this study. 27 feet with hammer toe deformity and 31 feet without hammer toe deformity were tested using standardized gonimetric, 3D digitizer and CT methods. ICCs (3,1), standard error of the measurement (SEM) values, and difference measures were used to characterize intrarater reliability. Pearson correlation coefficients and an analysis of variance were used to determine associations and differences between the measurement techniques.

Findings

3D digitizer and CT measures of MTPJ angle had high test–retest reliability (ICC=0.95–0.96 and 0.98–0.99, respectively; SEM=2.64–3.35° and 1.42–1.47°, respectively). Goniometry, 3D digitizer, and CT measures of tibial torsion had good test–retest reliability (ICC=0.75, 0.85, and 0.98, respectively; SEM=2.15°, 1.74°, and 0.72°, respectively). Both goniometric and 3D digitizer measures of MTPJ angle were highly correlated with CT measures of MTPJ angle (r=0.84–0.90, r=0.84–0.88, respectively) and tibial torsion (r=0.72, r=0.83). Goniometry, 3D digitizer, and CT measures were all different from each other for measures of hammer toe deformity (p<0.001). Goniometry measures were different from CT measures and 3D digitizer measures of tibial torsion (p<0.002). CT measures and 3D digitizer measures of tibial torsion were similar (p=0.112).

Interpretations

These results suggest that 3D digitizer and CT scan measures of MTPJ angle and goniometric, 3D digitizer, and CT scan measures of tibial torsion are reliable. Goniometer and 3D digitizer measures of MTPJ angle and tibial torsion measures are highly correlated with the gold standard CT method indicating good validity of measures, but the measures are not interchangeable.

Keywords: Hammer toe, Reliability, Validity