Background
Methods
Search strategy
Inclusion Criteria: | Exclusion Criteria: |
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• Studies describing a tool measuring metatarsus adductus. | • Studies describing congenital foot deformities with no inclusion of metatarsus adductus These included but were not limited to: skewfoot, congenital talipes equinovarus, metatarsus primus varus, congenital metatarsus varus or serpentine foot. |
• Studies reporting any measurement properties of measurement tools for assessing metatarsus adductus as defined by the COSMIN tool. • All study designs • Studies based on both adults and children | • Non-English publications. • Grey literature |
Data extraction
Critical appraisal of study methodology quality
Results
Included studies
Primary Author | Study Design | Country | Sample Size | Gender Male/ Female | Age (Age (SD), Range) | Measure | Inclusion Criteria | Exclusion Criteria | Data collection method | Tool developed by author: |
---|---|---|---|---|---|---|---|---|---|---|
Engel [35] | Retrospective cohort | USA | 571 radiographs | Not stated | Not stated | 1. Traditional metatarsus adductus angle (intersection of longitudinal axis of lesser tarsus with bisector of second metatarsal) 2. Simplified metatarsus angle (intersection of longitudinal bisector of 2nd metatarsal and medial cuneiform) | Foot radiographs from Oxford hospital. | Not stated | Weight-bearing foot radiographs | Yes |
Dawoodi [38] | Literature review | United Kingdom | Not stated | Not stated | Not stated | 1. Traditional metatarsus adductus angle (intersection of longitudinal axis of lesser tarsus with bisector of second metatarsal) 2. Engel’s angle (bisection of middle cuneiform with longitudinal axis of second metatarsal) 3. Modified Engel’s angle using the base of the middle cuneiform as a reference line | Not stated | Not stated | Not stated | No |
Dawoodi [32] | Validation study | United Kingdom | 130 patients (50 randomly selected radiographs) | 119/14 | 50.6 (15.4) years, 14–80 years | 1. Sgarlarto’s angle/traditional metatarsus adductus angle (angle between 2nd metatarsal and longitudinal axis of the lesser tarsus using 4th metatarso-cuboid joint as reference) 2. Rearfoot-2nd meta-tarsal angle 3. Engel’s angle (bisection of middle cuneiform with longitudinal axis of second metatarsal) 4. Modified Engel’s angle using the base of the middle cuneiform as a reference line | Symptomatic hallux abductovalgus, listed for corrective surgery | Evidence of trauma, Previous surgery | Dorsoplantar radiographic views. | No |
French [34] | Non-Controlled Trial | USA | 42 (68 ft) | 29/13 | 9.1 months 1–3 years | 1. Lateral calcaneal 5th Metatarsal angle (line representing the lateral aspect of calcaneus and the longitudinal bisector of the fifth metatarsal) 2. Inter-metatarsal angle (angle formed by longitudinal bisectors of 1st and 2nd metatarsals) 3. Talus first metatarsal angle (longitudinal bisectors of talus and the first metatarsals) 4. Talocalcaneal angle (Kite’s angle) (longitudinal bisector of the talus and the calcaneus) 5. First metatarsal fifth metatarsal angle (angle formed by longitudinal bisection of 1st and 5th metatarsals) 6. Talocaneal angle lateral view (bisection of talus and a line representing inferior aspect of the calcaneus) | Clinical observation of metatarsus adductus | Not stated | AP and lateral radiographs | First metatarsal -5th metatarsal angle only was author driven. |
Hutchinson [39] | Expert Opinion | USA | Not stated | Not stated | Not stated | Describes Kite’s talocalcaneal angle and calcaneal metatarsal angle without labeling of method | Not applicable | Not applicable | Radiographs | No |
Widhe [13] | Prospective cohort | Sweden | 2, 401 | Not stated | 0–16 years | Dynamic foot pressure and gait analysis | Not specifically stated. | Not stated | EMED dynamometric system | No |
Knörr [4] | Prospective cohort | Spain | 26 (34 ft) | 16/10 | 5.7 years, 3–8.5 years | 1. Heel bisector method (undescribed) 2. First cuneiform metatarsal angle (medial angulation of first cuneometatarsal joint) 3. Metatarsal-metaphyseal angle (metatarsal metaphyseal incurvation) | Rigid Metatarsus adductus scheduled for surgery | Not stated | Weight bearing radiographs | No |
Miron [21] | Expert Opinion | Canada | N/A | Not stated | Not stated | Lateral displacement of the medial (first) cuneiform over the navicular as the single feature. | Not applicable | Not applicable | Ultrasonography | Yes |
Lepow [25] | Retrospective cohort | USA | 15 | 7/8 | 6 months, (2–15 months) | 1. Traditional metatarsus adductus angle (intersection of longitudinal axis of lesser tarsus with bisector of second metatarsal). | Diagnosed with metatarsus adductus | No treatment No radiography | WB AP radiographs | No |
Herzenberg [20] | Prospective cohort | USA | 27 (43 ft) | Not stated | 3–9 months. | 1. Footprints analysed using modification of Bleck’s heel bisector method. A transparent template with longitudinal bisector was applied over footprint and graded 2. Talocalcaneal angle (Kite’s angle) (longitudinal bisector of the talus and the calcaneus) | < 9 months, Failed program of parent stretching | Children older than 9 months of age | Footprints | Yes |
Smith [19] | Expert Opinion | USA | Not applicable | Not applicable | Not applicable | Heel bisector drawn onto photocopy of a child’s footprint. A second copy in maximum correction for quantification of flexibility | N/A | N/A | Photocopied footprint | Yes |
Dominguez [33] | Retrospective cohort | Spain | 121 (20 randomly selected radiographs) | 106/103 | 23.88 years (2.85), 20–29 years | Metatarsus adductus angle - cuboid and the 4th metatarsal and cuboid and the 5th metatarsal | > 20 years No history of foot surgery or alteration in plantar pressures distribution | Disease or trauma causing foot pathology, pain, toe deformities | Dorsoplantar radiographs weight bearing | No |
Cook [23] | Retrospective cohort | USA | 40 ft | Not stated | 9 weeks – 9 months | Berg classification - talus-first metatarsal deviation, calcaneal line to cuboid, AP talocalcaneal line, lateral talocalcaneal angle | Metatarsus adductus diagnosis on clinical examination | Poor quality radiograph | Radiographs | no |
Berg [2] | Prospective cohort | USA | 84 | 50/34 | 2.5 years 2.2–3.8 | Talocalcaneal angle (Kite’s angle) (longitudinal bisector of the talus and the calcaneus) | Stretches failed to resolve metarasus adductus | Neurological conditions | AP weight-bearing radiographs | Yes |
Bleck [3] | Retrospective cohort | USA | 160 | 93/67 | 5–36 months | Heel bisector method: Severity measure: The heel bisector centres of the hindfoot plantar surface. Line crosses between the 2nd and 3rd toes = normal, through the 3rd toe (mild deformity), between 3rd and 4th toes (moderate), between 4th and 5th toes (severe deformity). Flexibility measure: Abduction beyond the midline heel bisector (mild classification), only to the midline (partially flexible), no abduction possible (severe) | Metatarsus adductus diagnosis on clinical examination | Dynamic hallux varus, metatarsus primus varus or serpentine foot. | Observation and physical assessment | Yes |
Reliability of measures employed to quantify metatarsus adductus
Radiographic angles: | Description of measurement: | Study | Intra-rater ICC: | Inter-rater ICC: |
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Traditional metatarsus adductus angle (5th) | Angle between the second metatarsal and longitudinal axis of the lesser tarsus using the fifth metatarso-cuboid joint as a reference | [32] | 0.92 | 0.87 |
[33] | 0.970 | 0.962 | ||
Modified metatarsus adductus angle (4th) | Angle between the second metatarsal and longitudinal axis of the lesser tarsus using the forth metatarso-cuboid joint as a reference | [38] | 0.91 | 0.93 |
[33] | 0.962 | 0.972 | ||
Rearfoot-2nd metatarsal angle | Angle between the longitudinal bisection of the second metatarsal bone and the line parallel to the lateral border of the calcaneum | [32] | 0.85 | 0.87 |
Engel’s angle | Angle between the longitudinal axis of the middle cuneiform and the longitudinal axis of the second metatarsal | [32] | 0.90 | 0.84 |
Modified Engel | Angle between the longitudinal axis of the second metatarsal and a line perpendicular to the proximal articular surface of the middle cuneiform and the angle between the rearfoot reference line (line parallel to the lateral border of the calcaneum) and the longitudinal axis of the second metatarsal | [32] | 0.92 | 0.91 |
The Berg Classification system | Four radiographic measurements that categorises foot deformities into; metatarsus adductus, complex metatarsus adductus, simple skewfoot and complex skewfoot This includes the following: talus-first metatarsal deviation, calcaneal line to cuboid, AP talocalcaneal line, lateral talocalcaneal angle | [23] | Average intra-rater consistency: 74% (ranged from 66.7–81%). | Average inter-rater consistency: 64% (ranged from 61.9–66.7%). |
Methodology quality of the included studies
Study: | Measurement tool: | Author driven: | Reliability (B): | Content Validity (D): | Criterion Validity (H): | Responsiveness (I): |
---|---|---|---|---|---|---|
Berg et al. [2] | Radiographs: Berg classification system | Yes | n/a | n/a | n/a | Poor |
Cook et al. [23] | Radiographs: Berg classification system | No | Poor | n/a | n/a | n/a |
Dawoodi et al. [32] | Radiographs: metatarsal angle (4th), modified metatarsal angle (5th), rearfoot – 2nd metatarsal angle, Engel’s Angle, modified Engel’s angle. | No | Good | n/a | n/a | n/a |
Dominguez et al. [33] | Radiographs: Traditional metatarsus adductus angle (cuboid and the 4th metatarsal as reference), modified metatarsus adductus angle (cuboid and the 5th metatarsal). | No | Fair | n/a | n/a | n/a |
Engel, et al. [35] | Radiographs: Traditional metatarsus adductus angle and the modified metatarsus adductus angle | Modified metatarsus adductus angle only. | n/a | n/a | Fair | n/a |
French, et al. [34] | Radiographs: Lateral calcaneal 5th metatarsal angle, inter-metatarsal angle, talus first metatarsal angle, talocalcaneal angle (Kite’s angle), first metatarsal fifth metatarsal angle, talocaneal angle (lateral view). | First-metatarsal fifth-metatarsal angle was author driven. All other angles were not. | n/a | Poor | n/a | Poor |
Herzenberg et al. [20] | Footprints analysed using a modified version of Bleck’s measurement. | Yes | n/a | n/a | n/a | Poor |
Knörr et al. [4] | Radiographs: First cuneiform metatarsal angle, metatarsal-metaphyseal angle. | No | n/a | n/a | n/a | Poor |
Lepow et al. [25] | Radiographs: Paediatric metatarsus adductus angle | Yes | n/a | n/a | n/a | Poor |