Accurate Determination of Relative Metatarsal Protrusion with a Small Intermetatarsal Angle: A Novel Simplified Method

Several published studies have explained in detail how to measure relative metatarsal protrusion on the plain film anteroposterior pedal radiograph. These studies have demonstrated the utility of relative metatarsal protrusion measurement in that it correlates with distal forefoot deformity or pathologic features. The method currently preferred by practitioners in podiatric medicine and surgery often presents one with the daunting challenge of obtaining an accurate measurement when the intermetatarsal 1-2 angle is small. The present study illustrates a novel mathematical solution to this problem that is simple to master, relatively quick to perform, and yields accurate results. Our method was tested and proven by 4 trained observers with varying degrees of clinical skill who independently measured the same 10 radiographs.