Identification of radiographic characteristics associated with pain in hallux valgus patients: A preliminary machine learning study

ObjectiveTo investigate the association between the structural deformity and foot pain in hallux valgus (HV) patients using a multi-variate pattern analysis (MVPA) approach. MethodsPlain radiographic metrics were calculated from 36 painful and 36 pain-free HV feet. In analysis 1, univariate analyses were performed to investigate the clinical and radiographic differences between painful and pain-free HV. In analysis 2, we investigated the pattern differences for radiographic metrics between these two groups using a MVPA approach utilizing a support vector machine. In analysis 3, sequential backward selection and exhaustive search were performed as a feature-selection procedure to identify an optimal feature subtype. In analysis 4, hierarchical clustering analysis was used to identify the optimal radiographic HV subtype associated with pain in HV. ResultsWe found that: (1) relative to feet with pain-free HV, the painful ones exhibited a higher hallux valgus angle, i.e., the magnitude of distal metatarsal and phalangeal deviation; (2) painful HV could be accurately differentiated from pain-free HV via MVPA. Using sequential backward selection and exhaustive search, a 5-feature subset was identified with optimal performance for classifying HV as either painful or pain-free; and (3) by applying hierarchical clustering analysis, a radiographic subtype with an 80% pain incidence was identified. ConclusionThe pain in HV is multifactorial and associated with a radiographic pattern measured by various angles on plain radiographs. The combination of hallux valgus angle, inter-phalangeal angle, distal metatarsal articular angle, metatarsal cuneiform angle and metatarsal protrusion distance showed the optimal classification performance between painful and pain-free HV.