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The Grading of Hallux Valgus

The Manchester Scale

Adam P. Garrow, MSc^*, Ann Papageorgiou, MSc, Alan J. Silman, MD, Elaine Thomas, MSc, Malcolm I. V. Jayson, MD^|| and Gary J. Macfarlane, PhD^¶

^* Research Podiatrist/Epidemiologist, Diabetes Foot Clinic, Disablement Services Centre, Withington Hospital, Cavendish Rd, Manchester M20 8LB, England. Submitted during doctoral studies, Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, The Medical School, University of Manchester, Manchester, England.
Study Coordinator, Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, The Medical School, University of Manchester, Manchester, England.
Professor of Rheumatic Disease Epidemiology, Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, The Medical School, University of Manchester, Manchester, England.
Submitted during doctoral studies, Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, The Medical School, University of Manchester, Manchester, England.
^|| Professor, Rheumatic Diseases Centre, Clinical Sciences Bldg, Hope Hospital, Salford, England.
^¶ Professor of Epidemiology, Arthritis Research Campaign Epidemiology Unit and Unit of Chronic Disease Epidemiology, School of Epidemiology and Health Sciences, The Medical School, University of Manchester, Manchester, England.

Abstract

This article describes a new, noninvasive method of assessing the severity of hallux valgus deformity by means of a set of standardized photographs. Six podiatrists were independently asked to grade the level of deformity of 13 subjects (26 feet) on a scale of 1 (no deformity) to 4 (severe deformity). The reliability of the four-point scale for the severity of hallux valgus was investigated by means of kappa-type statistics for more than two raters. The results showed that the grading method had excellent interobserver repeatability with a combined kappa-type statistic of 0.86, making it a suitable instrument for clinical and research purposes. (J Am Podiatr Med Assoc 91(2): 74-78, 2001)

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