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Table 2 Studies included within review

From: The identification and appraisal of assessment tools used to evaluate metatarsus adductus: a systematic review of their measurement properties

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
  1. *N/A Not applicable