Sex Determination Based on The Radiographic Examination of The Metatarsal Bones: A Retrospective Study in Ghanaian Hospitals

Background: Sex estimation, the process of classifying human remains as either male or female, is a fundamental step in forensic anthropology and archaeological investigations. This study aimed to evaluate the effectiveness of metatarsal bone length-to-width (L/W) ratios for sex determination, assessing their accuracy, age-related reliability, and sexual dimorphism in a Ghanaian population. Methods: A retrospective cross-sectional design was employed, analyzing radiographic data from 256 individuals (54.3% male, 45.3% female) aged 20–60 years. Measurements of the first (M1) and second (M2) metatarsals were obtained from digital radiographs, and L/W ratios were calculated. Statistical analyses included Receiver Operating Characteristic (ROC) curve analysis to assess discriminative power, interaction analysis to evaluate age effects, and Multivariate Analysis of Variance (MANOVA) to examine sexual dimorphism. Results: The study included 256 participants, with the majority being males (54.3%). Most of the participants (56.6%) were in early adulthood (18–41 years). The second metatarsal (M2) was longer than the first (M1) (M2: 70.13 ± 6.38 mm vs. M1: 57.84 ± 5.99 mm), while M1 was wider (M1: 19.64 ± 2.39 mm vs. M2: 13.73 ± 2.14 mm). ROC analysis revealed poor accuracy for sex determination, with area under the curve (AUC) values of 0.43 for M1 and 0.52 for M2. Age did not significantly influence the reliability of L/W ratios (p > 0.05). MANOVA confirmed significant sexual dimorphism in metatarsal dimensions (Wilks’ λ = 0.88, p < 0.0001), with males exhibiting larger bone sizes (length: +12–14%; width: +15–18%). Conclusion: Metatarsal bone measurements alone are insufficient for reliable sex determination in forensic contexts. However, when used in conjunction with other skeletal indicators, they can contribute to forensic investigations. Further research on population-specific variations is recommended.