From the Guidelines
To evaluate pathological valgus, standing long-leg (hip-to-ankle) views are the most appropriate radiographic examination, as they provide optimal assessment of alignment 4 and accurate information on the weight-bearing mechanical axis in patients with suspected lower limb malalignment 1. When evaluating pathological valgus, it is essential to consider the most effective imaging modalities to assess alignment and potential underlying conditions.
- Standing AP and lateral views, as well as a tangential axial view of the patellofemoral joint, are commonly used in the routine radiographic examination for evaluation of total knee arthroplasty 1.
- However, for optimal assessment of alignment, particularly in cases of suspected lower limb malalignment, standing long-leg (hip-to-ankle) views are recommended, as they provide accurate information on the weight-bearing mechanical axis 1.
- The use of AP radiographs taken in 10° of internal rotation may also improve the interpretation of varus and valgus alignment, compared to neutral AP views or those obtained in 10° of external rotation 1.
- It is crucial to note that while laboratory tests may be necessary to identify underlying metabolic or inflammatory conditions, they should complement clinical examination and imaging studies like weight-bearing radiographs, which remain essential for comprehensive evaluation of valgus deformities.
- The choice of imaging modality should be guided by the need to accurately assess alignment and identify potential underlying conditions, with standing long-leg (hip-to-ankle) views being the most appropriate initial examination for evaluating pathological valgus 1.
From the Research
Labs to Evaluate Pathological Valgus
To evaluate pathological valgus, several laboratory tests and imaging modalities can be utilized. The following are some of the key tests and findings:
- Radiographs (X-rays) are commonly used for the preoperative assessment of hallux valgus (HV) 2
- Magnetic Resonance Imaging (MRI) can be used to evaluate the qualitative soft tissue and internal derangement findings in hallux valgus 2
- Measurements of hallux valgus angle (HVA) and intermetatarsal angle (IMA) can be taken on radiographs and MRI to assess the severity of hallux valgus 2
- Laboratory tests such as rheumatoid factor (RF), anti-cyclic citrullinated peptide (CCP) antibody, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) can be used to diagnose and monitor rheumatoid arthritis, which can be associated with hallux valgus 3, 4, 5
- The combination of RF and anti-CCP antibody can be beneficial in confirming a diagnosis of rheumatoid arthritis 4
Imaging Features
Imaging features of post-operative hallux valgus can be complex and may require careful evaluation by a radiologist 6. The following are some of the key imaging features:
- Assessment of the first toe deformity correction is mainly visual and imaging is required to analyze the intermetatarsal angle and depict complications 6
- Imaging can be used to evaluate the bone mineralization and healing after osteotomies 6
- MRI can be used to evaluate the qualitative soft tissue and internal derangement findings in hallux valgus 2
Laboratory Tests
Laboratory tests can be used to diagnose and monitor rheumatoid arthritis, which can be associated with hallux valgus. The following are some of the key laboratory tests:
- Rheumatoid factor (RF) can be used to diagnose rheumatoid arthritis, but it has a lower specificity compared to anti-CCP antibody 3, 4
- Anti-cyclic citrullinated peptide (CCP) antibody has a higher specificity compared to RF and can be used to diagnose rheumatoid arthritis 3, 4
- C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can be used to monitor the inflammatory process in rheumatoid arthritis 4, 5