Do weight-bearing films affect decision making in hallux valgus surgery?

Hallux valgus is a complex deformity of the first ray and forefoot that can be surgically treated using different procedures and osteotomies. Preoperative planning includes anteroposterior and lateral plain films. The effect of weight-bearing on the results of the standardized measurements is still the subject of debate. We evaluated the effect of weight-bearing on the results of measurements and decision making by expert evaluators. A total of 21 foot and ankle surgeons were given weight-bearing and non-weight-bearing anteroposterior plain foot films of patients with hallux valgus. They were asked to measure 3 standard angles and then to select the most appropriate procedure from a short list. Using a paired Student's t test, no difference in the angles measured nor in the procedures chosen was detected between the weight-bearing and non-weight-bearing films. Although it is generally accepted that decisions regarding the treatment of hallux valgus should be based on plain weight-bearing films, in the present study, we established that non-weight-bearing films can reliably be used to choose the surgical procedure.