Does Conventional Radiography Overrepresent Joint Space Narrowing in Hallux Rigidus? A Comparative Study With Weightbearing CT Imaging

Ahmed Saleh; Vineel Mallavarapu; Nacime Salomao Barbachan Mansur; Aly M Fayed; Cesar de Cesar Netto

doi:10.1177/24730114261471159

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Does Conventional Radiography Overrepresent Joint Space Narrowing in Hallux Rigidus? A Comparative Study With Weightbearing CT Imaging

Journal article

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Peer reviewed

Does Conventional Radiography Overrepresent Joint Space Narrowing in Hallux Rigidus? A Comparative Study With Weightbearing CT Imaging

Ahmed Saleh, Vineel Mallavarapu, Nacime Salomao Barbachan Mansur, Aly M Fayed and Cesar de Cesar Netto

Foot & ankle orthopaedics, Vol.11(3), pp.1-8

07/2026

DOI: 10.1177/24730114261471159

PMID: 42621232

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Abstract

Conventional weightbearing radiographs are the gold standard for grading hallux rigidus (HR), yet clinical symptoms often do not correlate with radiographic severity. This study compared 2-dimensional (2D) weightbearing radiographs with weightbearing computed tomography (WBCT) to evaluate if traditional imaging overrepresents joint degeneration. A retrospective study of 21 patients (13 males; average age 55.9 years) with HR was conducted. All patients had both weightbearing radiographs and WBCT. Two fellowship-trained orthopaedic surgeons measured the first metatarsophalangeal joint (first MTPJ) space, dorsal osteophyte height, and dorsal narrowing percentage. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). Joint space width was significantly larger on WBCT (1.9 ± 0.44 mm) compared to radiographs (0.92 ± 0.53 mm; < .001). WBCT also showed significantly less narrowing of the dorsal articular surface (22.78% ± 8.71% vs 46.57% ± 18.8%, < .001). Inter-rater reliability for joint space narrowing was excellent for WBCT (ICC = 0.91) but moderate for radiographs (ICC = 0.67; < .001). WBCT was more sensitive in detecting loose bodies and sesamoid changes. WBCT demonstrated consistently larger joint-space measurements and less dorsal joint-space narrowing compared with conventional radiographs, along with substantially higher inter-rater reliability for joint space narrowing. These findings indicate a systematic measurement difference between modalities, with radiographs tending to overrepresent joint-space loss. This discrepancy may help explain why joint-preserving procedures such as cheilectomy can succeed even when radiographs appear advanced. Level III, retrospective comparative study.

weightbearing CT

hallux limitus

hallux rigidus

WBCT

cheilectomy

Coughlin classification

Details

Title: Subtitle: Does Conventional Radiography Overrepresent Joint Space Narrowing in Hallux Rigidus? A Comparative Study With Weightbearing CT Imaging
Creators: Ahmed Saleh - Tanta University
Vineel Mallavarapu - Loyola University Medical Center
Nacime Salomao Barbachan Mansur - MedStar Union Memorial Hospital
Aly M Fayed - University of Iowa
Cesar de Cesar Netto - Duke University
Resource Type: Journal article
Publication Details: Foot & ankle orthopaedics, Vol.11(3), pp.1-8
DOI: 10.1177/24730114261471159
PMID: 42621232
NLM abbreviation: Foot Ankle Orthop
ISSN: 2473-0114
eISSN: 2473-0114
Publisher: Sage
Language: English
Date published: 07/2026
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9985219326402771

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