Reliability of Hallux Rigidus Radiographic Grading System


  • Ryan C. Pate University of Kansas Medical Center:KU School of Medicine-Wichita, 1010 North Kansas, Wichita, KS 67214-3199, USA.
  • John W. Fanning
  • Naomi N. Shields
  • Alexander C.M. Chong



hallus rigidus, radiography, reliability


Introduction. The purpose of this study was to determine the inter- and intra-observer reliability of a clinical radiographic scale for hallux rigidus. Methods. A total of 80 patients were retrospectively selected from the patient population of two foot and ankle orthopaedic surgeons. Each corresponding series of radiographic images (weight-bearing anteroposterior, weight-bearing lateral, and oblique of the foot) was randomized and evaluated. Re-randomization was performed and the corresponding radiograph images re-numbered. Four orthopaedic foot and ankle surgeons graded each patient, and each rater reclassified the re-randomized radiographic images three weeks later. Results. Sixty-one out of 80 patients (76%) were included in this study. For intra-observer reliability, most of the raters showed “excellent” agreement except one rater had a “substantial” agreement. For inter-observer reliability, only 14 out of 61 cases (23%) showed total agreement between the eight readings from the four surgeons, and 11 out of the 14 cases (79%) were grade 3 hallux rigidus. One of the raters had a tendency to grade at a higher grade resulting in poorer agreement. If this rater was excluded, the results demonstrated a “substantial” agreement by using this classification. Conclusion. The hallux rigidus radiographic grading system should be used with caution. Although there is an “excellent” level of intra-observer agreement, there is only “moderate” to “substantial” level of inter-observer reliability.


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Original Research

How to Cite

Pate, R. C., Fanning, J. W., Shields, N. N., & Chong, A. C. (2015). Reliability of Hallux Rigidus Radiographic Grading System. Kansas Journal of Medicine, 8(4), 125-134.