title: How reliable are standard radiographic measures of the foot and ankle in children with achondroplasia?
abstract: BACKGROUND
  Radiographic measurements are typically used in achondroplasia (ACH) during correction of lower limb alignment. However, reliabilities for the measurements on weightbearing radiographs of the foot and ankle in patients with ACH have not been described, and the differences between the ACH population and subjects without ACH likewise have not been well characterized; these issues limit the use of studies on this subject.
  
  
  OBJECTIVE
  We proposed (1) to measure the inter- and intraobserver reliability of a number of radiographic measures of ankle and foot alignment in an achondroplastic cohort of patients; and (2) to compare our radiographic measurement values with age-matched literature-based normative values.
  
  
  METHODS
  Ten radiographic measurements were applied to foot and ankle radiographs of 20 children (40 feet) with ACH (mean age, 10 years; range, 8-16 years). Interobserver and intraobserver reliabilities of these radiographic measurement methods were obtained and expressed by intraclass correlation coefficients (ICCs). The mean values were calculated and compared with the literature-based values.
  
  
  RESULTS
  The interobserver reliability was excellent for eight measurements with ICCs ranging from 0.801 to 0.962, except for lateral talo-first metatarsal angle and mediolateral column ratio, which were much lower. The intraobserver reliability was excellent for all 10 radiographic measurements with ICCs ranging from 0.812 to 0.998. Compared with existing literature-based values, all 10 measurements had a significant difference (p < 0.01).
  
  
  CONCLUSIONS
  We suggest tibiotalar angle, calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, metatarsal stacking angle, and AP talo-first metatarsal angle with excellent interobserver and intraobserver reliabilities should be considered preferentially in analysis of foot and ankle alignment in children with ACH.
authors.affiliation: Medical College of Soochow University, Suzhou, Jiangsu Province, PR China.
authors.forename: Jia
authors.initials: J
authors.lastname: Xu
authors.forename: Kwang-Won
authors.initials: KW
authors.lastname: Park
authors.forename: Qing-Lin
authors.initials: QL
authors.lastname: Kang
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Jung
authors.forename: Hae-Ryong
authors.initials: HR
authors.lastname: Song
mesh_terms: D000130:Achondroplasia / Q000000981:diagnostic imaging*; D000293:Adolescent; D000842:Ankle / Q000000981:diagnostic imaging*; D000843:Ankle Joint / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging*; D033023:Foot Joints / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D015588:Observer Variation; D011859:Radiography