Abstract
INTRODUCTION: We developed a smartphone application capable of automatically measuring the hallux valgus angle (HVA) and various intermetatarsal angles by capturing radiographic images displayed on a monitor. This study aimed to evaluate the accuracy of these measurements using the application. METHODS: Three users-a board-certified orthopedic surgeon, a resident, and a nonhealthcare professional (Users 1, 2, and 3)-independently used the application to measure angles on 92 radiographs from 92 consecutive patients. Mean absolute errors (MAEs) between the application-based measurements and the median of manual measurements performed by three experienced foot and ankle surgeons using a DICOM viewer were calculated for each user. To evaluate whether the measurement errors were acceptably small, one-sided t-tests were conducted to determine whether the MAEs were significantly less than 3°. Differences in MAEs among the three users were also assessed using analysis of variance. RESULTS: The MAEs of HVA by the three users were 1.1°, 1.3°, and 1.4°, respectively, all significantly below the 3° threshold (95% CI upper limit; 1.2°, 1.5°, and 1.5°). Comparable accuracy was observed for intermetatarsal angles, which have slightly greater variability for more lateral metatarsals. All measurements met the accuracy criterion of < 3°, except for the intermetatarsal angles between the first and fifth metatarsals measured by the nonhealthcare user. No significant difference in MAE was found among users for HVA (p = 0.13), whereas significant differences were noted for some intermetatarsal angles. CONCLUSIONS: The developed smartphone application accurately measured the HVA and various intermetatarsal angles, with performance comparable to that of experienced foot and ankle surgeons. Importantly, sufficient accuracy was achieved even when used by individuals without clinical training. The application may be useful as a practical tool in clinical and research settings.