• 1

    Root ML, Orien WP, Weed JH: “Normal and Abnormal Function of the Foot,” in Clinical Biomechanics, Vol 2, p 349, Clinical Biomechanics Corp, Los Angeles, 1977..

  • 2

    Clough JG, Marshall JH: The etiology of hallux abducto valgus: a review of the literature. .JAPMA 75::238. ,1985. .

  • 3

    Shoenhaus HD, Cohen RS: Etiology of the bunion. .J Foot Surg 31::25. ,1992. .

  • 4

    Kusumoto A, Suzuki T, Kumakura C, et al: A comparative study of foot morphology between Filipino and Japanese women, with reference to the significance of a deformity like hallux valgus as a normal deviation. .Ann Hum Biol 23::373. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Piggott H: The natural history of hallux valgus in adolescence and early life. .J Bone Joint Surg Br 42::749. ,1960. .

  • 6

    Kelikian H: Hallux Valgus, Allied Deformities of the Forefoot and Metatarsalgia, p 112, WB Saunders, Philadelphia, 1965..

    • Crossref
    • Export Citation
  • 7

    Hardy RH, Clapham JCR: Observations on hallux valgus: based on a controlled series. .J Bone Joint Surg Br 33::376. ,1951. .

  • 8

    Shereff MJ, DiGiovanni L, Bejjani FJ, et al: A comparison of nonweight-bearing and weight-bearing radiographs of the foot. .Foot Ankle 10::306. ,1990. .

  • 9

    Smith RW, Reynolds JC, Stewart MJ: Hallux valgus assessment: report of Research Committee of American Orthopaedic Foot and Ankle Society. .Foot Ankle 5::92. ,1984. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Houghton GR, Dickson RA: Hallux valgus in the younger patient: the structural abnormality. .J Bone Joint Surg Br 61::176. ,1979. .

  • 11

    Kalen V, Brecher A: Relationship between adolescent bunions and flatfeet. .Foot Ankle 8::332. ,1988. .

  • 12

    McCormick A, Fleming D, Charlton J: Morbidity Statistics from General Practice: Fourth National Study 1991-1992, p 25, Her Majesty’s Stationery Office, London, 1995..

  • 13

    Duthie RB, Bentley G: Mercer’s Orthopaedic Surgery, 8th Ed, p 1041, Edward Arnold, London, 1983..

  • 14

    Ross FD: The relationship of abnormal foot pronation to hallux abducto valgus: a pilot study. .Prosthet Orthot Int 10::72. ,1986. .

  • 15

    Kilmartin TE, Barrington RL, Wallace WA: Metatarsus primus varus: a statistical study. .J Bone Joint Surg Br 73::937. ,1991. .

  • 16

    Shine IB: Incidence of hallux valgus in a partially shoe-wearing community. .BMJ 1::1648. ,1965. .

  • 17

    Clarke M: Trouble with Feet, p 87, G Bell & Son Ltd, London, 1969..

  • 18

    Elveru RA, Rothstein JM, Lamb RL: Goniometric reliability in a clinical setting: subtalar and ankle joint measurements. .Phys Ther 68::672. ,1988. .

  • 19

    Efron N: Grading scales for contact lens complications. .Opthalmic Physiol Opt 18::182. ,1998. .

  • 20

    Niessen AGJE, Van Den Berg TJTP, Langerhorst CT, et al: Grading of retinal nerve fiber layer with a photographic reference set. .Am J Ophthalmol 120::577. ,1995. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Kraemer HC: Ramification of a population model of κ as a coefficient of reliability. .Psychometrika 44::461. ,1979. .

  • 22

    Roberts C: Measurement Error in Categorical Clinical Data: Analysis and Interpretation [dissertation], p 118, University of Manchester, Manchester, England, 1995..

  • 23

    Kilmartin TE, Barrington RL, Wallace WA: The x-ray measurement of hallux valgus: an inter- and intra-observer error study. .Foot 2::7. ,1992. .

    • Search Google Scholar
    • Export Citation
  • 24

    Silman AJ: Epidemiological Studies: A Practical Guide, p 74, Press Syndicate of the University of Cambridge, Cambridge, England, 1995..

The Grading of Hallux Valgus

The Manchester Scale

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  • 1 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.
  • | 2 Study Coordinator, Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, The Medical School, University of Manchester, Manchester, England.
  • | 3 Professor of Rheumatic Disease Epidemiology, Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, The Medical School, University of Manchester, Manchester, England.
  • | 4 Submitted during doctoral studies, Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, The Medical School, University of Manchester, Manchester, England.
  • | 5 Professor, Rheumatic Diseases Centre, Clinical Sciences Bldg, Hope Hospital, Salford, England.
  • | 6 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.
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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)