Reproducibility of Radiographic Measurements in Assessment of Congenital Talipes Equinovarus

Six commonly measured parameters in the assessment of congenital clubfoot were retrospectively assessed from standardized preoperative and intraoperative radiographs taken during operative complete subtalar release. These radiographic parameters were measured in 30 feet by 6 observers at 2 separate readings. The observers were orthopedic residents in different stages of training. Between- observers intraclass correlation coefficients (ICCs) were computed for each parameter. All radiographic parameters were found to be reproducible across time and observers (range of preoperative intraobserver ICCs, 0.84-0.99; range of preoperative interobserver ICCs, 0.93-0.99), except for intraoperative anteroposterior (AP) talar–first metatarsal angle (intraoperative intraobserver ICC, 0.79) and lateral talocalcaneal angle (intraoperative interobserver ICC, 0.81). Differences in mean preoperative measurements between observers and time were tested by analysis of variance. There were no significant differences between observers and time in the 6 preoperative measurements (P>.05), except for intraoperative AP talar–first metatarsal angle, AP talocalcaneal angle, and degree of AP calcaneocuboid subluxation, which were significantly different (P<.05). Our results support use of radiographs as a reliable method for guiding care in patients with clubfoot and as a reproducible method that physicians can use for comparisons.