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Reliability of visual measurement of forefoot alignment

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Two articles on PainSci cite Cornwall 2004: (1) Complete Guide to Plantar Fasciitis(2) Is Diagnosis for Pain Problems Reliable?

PainSci notes on Cornwall 2004:

This is one of those fun studies that catches clinicians in their inability to come up with the same assessment of a structural problem. Three doctors were asked to “rate forefoot alignment,” but they didn’t agree. From the abstract: “ … the commonplace method of visually rating forefoot frontal plane deformities is unreliable and of questionable clinical value.”

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: The purpose of this study was to determine the interrater reliability of visual rating of forefoot frontal plane deformities among clinicians with different training.

METHODS: Thirty individuals (16 men and 14 women) between the ages of 22 and 52 years of age participated in the study. None of the patients had a history of congenital deformity, pain, or trauma in the lower extremities during the 6 months before the study. Three clinicians of different educational backgrounds and experience visually evaluated each of the patients and rated forefoot alignment. None of the clinicians knew the rating assigned by either of the other two clinicians.

RESULTS: The results of this study showed that two of the clinical raters agreed 61.7% of the time, but neither of them agreed with the third clinician more than 15% of the time.

CONCLUSION: This study indicates that the commonplace method of visually rating forefoot frontal plane deformities is unreliable and of questionable clinical value.

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