Effect of load-bearing radiographs on hallux valgus surgical planning

Introduction : Patients often present to the clinic with radiographs taken without weight bearing. However, weight-bearing radiographs are typically required for surgical planning, resulting in additional cost and radiation exposure. Aim : This study aimed to evaluate the effect of weight-bearing X-ray imaging on angular measurements and clinical decision-making in patients with hallux valgus. Materials and methods : Sixty-one feet from thirty-two patients presenting to our hospital in 2023–2024 were included. Hallux valgus angle (HVA) and intermetatarsal angle (IMA) measurements were compared between weight-bearing and non-weight-bearing radiographs. The association between these imaging differences and surgical decision-making was analyzed. Results : HVA was significantly higher on non-weight-bearing radiographs, whereas IMA was significantly higher on weight-bearing radiographs ( p =0.004 and p <0.001, respectively). Surgical planning differed between the two imaging modalities in only 2 of 61 feet (3.3%). Conclusion : Despite measurable differences in angular values, non-weight-bearing radiographs can be reliably used for preoperative planning in most cases. Surgeons often base their decisions on experience and preferred techniques rather than small variations in measurements.