{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:04:44Z","timestamp":1760238284573,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2020,8,2]],"date-time":"2020-08-02T00:00:00Z","timestamp":1596326400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: The diagnostic of flat and crest-shaped of first metatarsal heads has been associated as an important risk factor for hallux deformities, such as hallux valgus and hallux rigidus. The rounded form of the first metatarsal head on the dorsoplantar radiograph of the foot has been believed to be associated with the development of hallux valgus. Purpose: The aim of this study was to clarify the effect of tube angulation on the distortion of first metatarsal head shape, and verify the real shape of the metatarsal head in anatomical dissection after an X-ray has been taken. Materials and Methods: In this prospective study at Universidad Complutense de Madrid, from December 2016 to June 2019, 103 feet from embalmed cadavers were included. We performed dorsoplantar radiograph tube angulation from 0\u00b0 until 30\u00b0 every 5\u00b0 on all specimens; then, two observers verified the shape of the first metatarsal head in the radiographs and after its anatomic dissection. Kappa statistics and McNemar Bowker tests were used to assess and test for intra and interobserver agreement of metatarsal shape. Results: We calculated the intraobserver agreement, and the results showed that the first metatarsal head is distorted and crested only when the angle of the X-ray beam is at 20\u00b0 of inclination (p &lt; 0.001). The interobserver agreement showed good agreement at 0\u00b0, 5\u00b0, 10\u00b0, 20\u00b0, and 25\u00b0 and was excellent at 30\u00b0 (p &lt; 0.001). Conclusion: All of the studies that we identified in the literature state that there are three types of shapes of the first metatarsal head and relate each type of head to the diagnosis of a foot pathology, such as hallux valgus or hallux rigidus. This study demonstrates that there is only the round-shaped form, and not three types of metatarsal head shape. Therefore, no diagnoses related to the shape of the first metatarsal head can be made.<\/jats:p>","DOI":"10.3390\/diagnostics10080552","type":"journal-article","created":{"date-parts":[[2020,8,3]],"date-time":"2020-08-03T03:16:46Z","timestamp":1596424606000},"page":"552","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Radiographic Analysis on the Distortion of the Anatomy of First Metatarsal Head in Dorsoplantar Projection"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7667-5384","authenticated-orcid":false,"given":"Jessica","family":"Grande-del-Arco","sequence":"first","affiliation":[{"name":"Facultad de Enfermer\u00eda, Fisioterapia y Podolog\u00eda, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1568-7602","authenticated-orcid":false,"given":"Ricardo","family":"Becerro-de-Bengoa-Vallejo","sequence":"additional","affiliation":[{"name":"Facultad de Enfermer\u00eda, Fisioterapia y Podolog\u00eda, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3821-949X","authenticated-orcid":false,"given":"Patricia","family":"Palomo-L\u00f3pez","sequence":"additional","affiliation":[{"name":"University Center of Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9818-6290","authenticated-orcid":false,"given":"Daniel","family":"L\u00f3pez-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coru\u00f1a, 15403 Ferrol, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6569-1311","authenticated-orcid":false,"given":"C\u00e9sar","family":"Calvo-Lobo","sequence":"additional","affiliation":[{"name":"Facultad de Enfermer\u00eda, Fisioterapia y Podolog\u00eda, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1242-3831","authenticated-orcid":false,"given":"Eduardo","family":"P\u00e9rez-Boal","sequence":"additional","affiliation":[{"name":"Facultad de Enfermer\u00eda, Fisioterapia y Podolog\u00eda, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7588-2069","authenticated-orcid":false,"given":"Marta Elena","family":"Losa-Iglesias","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Alcorc\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8210-6789","authenticated-orcid":false,"given":"Carlos","family":"Martin-Villa","sequence":"additional","affiliation":[{"name":"Facultad de Enfermer\u00eda, Fisioterapia y Podolog\u00eda, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Rodriguez-Sanz","sequence":"additional","affiliation":[{"name":"Facultad de Enfermer\u00eda, Fisioterapia y Podolog\u00eda, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1053\/j.jfas.2009.05.003","article-title":"Epidemiological Aspects of the Surgical Correction of Structural Forefoot Pathology","volume":"48","author":"Meyr","year":"2009","journal-title":"J. Foot Ankle Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.joca.2010.03.011","article-title":"Are hallux valgus and big toe pain associated with impaired quality of life? A cross-sectional study","volume":"18","author":"Abhishek","year":"2010","journal-title":"Osteoarthr. Cartil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1002\/art.23709","article-title":"Prevalence and associations of hallux valgus in a primary care population","volume":"59","author":"Roddy","year":"2008","journal-title":"Arthritis Care Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1177\/107110070502600610","article-title":"Gait instability in older people with hallux valgus","volume":"26","author":"Menz","year":"2005","journal-title":"Foot Ankle Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1093\/ageing\/25.1.29","article-title":"Physiological factors and medications as predictors of injurious falls by elderly people: A prospective population-based study","volume":"25","author":"Koski","year":"1996","journal-title":"Age Ageing"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.apmr.2010.09.024","article-title":"Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults","volume":"92","author":"Spink","year":"2011","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.joca.2012.06.007","article-title":"Characteristics of foot structure and footwear associated with hallux valgus: A systematic review","volume":"20","author":"Nix","year":"2012","journal-title":"Osteoarthr. Cartil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"759","DOI":"10.3113\/FAI.2007.0759","article-title":"Hallux Valgus: Demographics, Etiology, and Radiographic Assessment","volume":"28","author":"Coughlin","year":"2007","journal-title":"Foot Ankle Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1302\/0301-620X.33B3.376","article-title":"Observations on hallux valgus; based on a controlled series","volume":"33B","author":"Hardy","year":"1951","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1177\/107110070202300308","article-title":"The shape of the metatarsal head as a cause of hallux abductovalgus","volume":"23","author":"Ferrari","year":"2002","journal-title":"Foot Ankle Int."},{"key":"ref_11","unstructured":"Mann, R., and Coughlin, M.J. (1999). Adult hallux valgus. Surgery of the Foot and Ankle, Mosby."},{"key":"ref_12","first-page":"105","article-title":"Morphology of the first metatarsal head as a risk factor for hallux valgus interphalangeus","volume":"26","author":"Strydom","year":"2018","journal-title":"Foot Ankle Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.foot.2008.07.002","article-title":"Cross-sectional study to evaluate radiological parameters in hallux rigidus","volume":"19","author":"Beeson","year":"2009","journal-title":"Foot"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.2106\/00004623-200710000-00010","article-title":"The shape of the lateral edge of the first metatarsal head as a risk factor for recurrence of hallux valgus","volume":"89","author":"Okuda","year":"2007","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.cpm.2013.12.002","article-title":"Biodynamics of Hallux Abductovalgus Etiology and Preoperative Evaluation","volume":"31","author":"Burns","year":"2014","journal-title":"Clin. Podiatr. Med. Surg."},{"key":"ref_16","first-page":"506","article-title":"First metatarsal head shape in juvenile hallux abducto valgus","volume":"30","author":"Kilmartin","year":"1991","journal-title":"J. Foot Surg."},{"key":"ref_17","unstructured":"Gerbert, J. (1991). Preoperative evaluation of the bunion patient: Etiology, biomechanics, clinical and radiographic assessment. Textbook of Bunion Surgery, Futura Publishing Co.. [2nd ed.]."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"300","DOI":"10.7547\/87507315-78-6-300","article-title":"Shape of the first metatarsal head in hallux rigidus and hallux valgus","volume":"78","author":"Brahm","year":"1988","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_19","unstructured":"Laporta, D.M., Melillo, T.V., and Hetherington, V.J. (2002). Preoperative Assessment in Hallux Valgus. Hallux Valgus Forefoot Surg., 107\u2013123. Available online: https:\/\/www.kent.edu\/sites\/default\/files\/HV-ch-06-Preoperative-Assessment-in-Hallux-Valgus.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.fas.2017.04.017","article-title":"Quantitative relationship of first metatarsophalangeal head morphology to hallux rigidus and hallux valgus","volume":"24","author":"Michelson","year":"2018","journal-title":"Foot Ankle Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1177\/107110070602701208","article-title":"First Metatarsal Bone: An Anatomic Study","volume":"27","author":"ElSaid","year":"2006","journal-title":"Foot Ankle Int."},{"key":"ref_22","unstructured":"Duvries, H.L. (1959). Static deformities. Surgery of the Foot, Mosby."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"119","DOI":"10.2214\/ajr.155.1.2112832","article-title":"Hallux valgus deformity: Preoperative radiologic assessment","volume":"155","author":"Karasick","year":"1990","journal-title":"Am. J. Roentgenol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1053\/j.jfas.2003.09.001","article-title":"The zero-plus first metatarsal and its relationship to bunion deformity","volume":"42","author":"Mancuso","year":"2003","journal-title":"J. Foot Ankle Surg."},{"key":"ref_25","first-page":"21","article-title":"Factores predisponentes del Hallux Valgus: Valoraci\u00f3n Radiol\u00f3gica","volume":"9","year":"1995","journal-title":"Rev. Med. Cir. Pie."},{"key":"ref_26","first-page":"356","article-title":"Factores morfol\u00f3gicos que influyen en el hallux valgus","volume":"42","author":"Beltoldi","year":"1998","journal-title":"Rev. Esp. Cir. Ortop. Traumatol."},{"key":"ref_27","first-page":"54","article-title":"Relationship between hallux valgus and first metatarsal head shape","volume":"50","author":"Fellner","year":"1995","journal-title":"J. Br. Podiatr Med."},{"key":"ref_28","unstructured":"Martin, D.E., and Pontious, J. (2012). Introduction and Evaluation of Hallux Abducto Valgus. McGlamry\u2019s Comprehensive Textbook of Foot and Ankle Surgery, Wolters Kluwer Health."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"544","DOI":"10.7547\/87507315-64-8-544","article-title":"X-ray evaluation of hallux abducto valgus deformity","volume":"64","author":"Laporta","year":"1974","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_30","first-page":"357","article-title":"Hallux valgus","volume":"46","author":"Coughlin","year":"1997","journal-title":"Instr. Course Lect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1177\/107110070302401002","article-title":"Hallux rigidus: Demographics, etiology, and radiographic assessment","volume":"24","author":"Coughlin","year":"2003","journal-title":"Foot Ankle Int."},{"key":"ref_32","unstructured":"Coughlin, M.J., Saltzman, S.L., and Anderson, R.B. (2007). Hallux valgus. Mann\u2019s Surgery of the Foot and Ankle, Saunders\/Elsevier."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1259\/0007-1285-24-277-18","article-title":"Sources of Error in the Production and Measurement of Standard Radiographs of the Foot","volume":"24","author":"Venning","year":"1951","journal-title":"Br. J. Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.3928\/0147-7447-19891101-11","article-title":"Radiographic distortion of bones: A marker study","volume":"12","author":"Stevens","year":"1989","journal-title":"Orthopedics"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1177\/107110079001000604","article-title":"A comparison of nonweight-bearing and weight-bearing radiographs of the foot","volume":"10","author":"Shereff","year":"1990","journal-title":"Foot Ankle"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"465","DOI":"10.7547\/87507315-57-10-465","article-title":"Differences in x-ray findings with varied positioning of the foot","volume":"57","author":"Hlavac","year":"1967","journal-title":"J. Am. Podiatry Assoc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/S0891-8422(23)00112-X","article-title":"Surgical radiology","volume":"5","author":"Kaschak","year":"1988","journal-title":"Clin. Podiatr. Med. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Tanaka, Y., Takakura, Y., Takaoka, T., Akiyama, K., Fujii, T., and Tamai, S. (1997). Radiographic analysis of hallux valgus in women on weightbearing and nonweightbearing. Clin. Orthop. Relat. Res., 186\u2013194.","DOI":"10.1097\/00003086-199703000-00026"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1177\/107110079401501206","article-title":"Reliability of Standard Foot Radiographic Measurements","volume":"15","author":"Saltzman","year":"1994","journal-title":"Foot Ankle Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1177\/107110078400500208","article-title":"Hallux valgus assessment: Report of research committee of American Orthopaedic Foot and Ankle Society","volume":"5","author":"Smith","year":"1984","journal-title":"Foot Ankle"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7547\/1000001","article-title":"Radiographic image distortion between the distal edge of the first metatarsal and the tibial sesamoid: Establishing a reliable radiographic relationship","volume":"100","author":"Durrant","year":"2010","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"205","DOI":"10.2106\/00004623-199502000-00006","article-title":"Radiographic analysis of hallux valgus. A two-dimensional coordinate system","volume":"77","author":"Tanaka","year":"1995","journal-title":"J. Bone Jt. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1177\/107110079902001005","article-title":"Hindfoot alignment of hallux valgus evaluated by a weightbearing subtalar x-ray view","volume":"20","author":"Tanaka","year":"1999","journal-title":"Foot Ankle Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Mark Davies, A., Whitehouse, R., and Jenkins, J. (2003). Imaging of the Foot & Ankle: Techniques and Applications, Springer.","DOI":"10.1007\/978-3-642-59363-5"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/10\/8\/552\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:53:46Z","timestamp":1760176426000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/10\/8\/552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,2]]},"references-count":45,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,8]]}},"alternative-id":["diagnostics10080552"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics10080552","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2020,8,2]]}}}