Influence of investigator experience on reliability of adult acquired flatfoot deformity measurements using weightbearing computed tomography

Foot Ankle Surg. 2019 Aug;25(4):495-502. doi: 10.1016/j.fas.2018.03.001. Epub 2018 Mar 12.


Background: Our purpose was to assess the reliability of measurements of adult-acquired flatfoot deformity (AAFD) taken by investigators of different levels of clinical experience using weightbearing computed tomography (WBCT).

Methods: Nineteen AAFD patients underwent WBCT. Three investigators with different levels of clinical experience made AAFD measurements in axial, coronal, and sagittal planes. Intra- and interobserver reliability were assessed. Mean values for each measurement were compared between investigators.

Results: After a training protocol, substantial to perfect intra- and interobserver reliability was observed for most measures, regardless of the investigator's experience level. Significant differences between investigators were observed in 2 of 21 measured parameters: medial cuneiform-first metatarsal angle (P=0.003) and navicular-medial cuneiform angle (P=0.001).

Conclusions: AAFD radiographic measurements can be performed reliably by investigators with different levels of clinical experience using WBCT.

Level of evidence: Level II, prospective comparative study.

Keywords: Adult acquired flatfoot deformity; Flatfoot; Measurement; Weightbearing; Weightbearing computed tomography.

MeSH terms

  • Adult
  • Body Weights and Measures
  • Clinical Competence*
  • Female
  • Flatfoot / diagnostic imaging*
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Prospective Studies
  • Reproducibility of Results
  • Tomography, X-Ray Computed
  • Weight-Bearing*