Patient-reported outcome after hallux valgus surgery — a two year follow up
Introduction
Hallux valgus (HV) is a deformity of the forefoot producing painful disability. Estimates of the prevalence of the HV vary widely, ranging from 21 to 70% in epidemiologic studies [1], [2]. The prevalence is higher in women and increases with age [1]. The deformity is characterized by lateral deviation of the great toe, medial deviation of the first metatarsal bone including progressive subluxation of the first metatarsophalangeal joint. The patients’ complaints are (i) restrictions of wearing shoes, (ii) pain over the medial eminence, (iii) pain underneath the second metatarsal head, and (iv) cosmetic concerns. HV deformity is also associated with poor balance, immobility and increased risk of falling [3]. These different aspects of the patients’ problems contribute to the fact that patient-reported outcome measures (PROMs) are of great importance.
Non-surgical treatment of HV deformity includes shoe modifications, splints and physical therapy [4], [5], [6], [7]. When non-surgical treatment has failed several methods of surgical treatment including osteotomies, soft tissue procedures and fusions can be performed. There are several studies evaluating the outcome after HV surgery, but most of them are small, retrospective and do not include PROMs [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. The most commonly used outcome measure after HV surgery is the American Orthopaedic Foot and Ankle Society (AOFAS) score [19], which is partially clinician-reported and can for that reason not be considered as a true PROM.
In a recently published review by Schrier et al. the Manchester-Oxford Foot Questionnaire (MOXFQ) and the Self-reported Foot and Ankle Score (SEFAS) were identified as the most suitable PROMs for assessment of HV treatment [20]. This recommendation supports our aim to evaluate the patient-reported outcome with the SEFAS after HV surgery in a two year follow-up study.
Section snippets
Material and methods
In this prospective study design we consecutively included patients scheduled for surgery due to hallux valgus at two orthopedic departments in the south part of Sweden, during the period January 1st 2010 to June 30st 2013. Two surgeons who used the same surgical indications performed all the operations. All patients included had a mild or moderate hallux valgus deformity and 9 of the patients had a concomitant hammertoe deformity at the second toe. All patients had before surgery failed
Results
In the two year follow up 53 (50 women) out of 80 patients (66%) completed all postoperative PROMs. The mean age was 55 (SD 14.1) years and the mean BMI 26.0 (SD 4.5) kg/m2. The 27 (25 women) excluded patients did not complete follow up data on all 3 occasions despite two reminders. The mean age for this group of patients was 55 (SD 12.3) years and the mean BMI 26.1 (SD 4.6) kg/m2.
The patients preoperatively reported impaired function, significant pain and reduced Health-related Quality of life
Discussion
Patients who underwent surgery due to HV reported diminished pain, improved function and HrQoL. The greatest improvement was found already at 6 months and remained unchanged up to 24 months postoperatively. This was shown by PROMs; both the generic ones and the foot-and ankle-specific SEFAS.
SEFAS has in earlier studies shown good psychometric properties [21], [22], [23], [24] and is recommended for assessment of HV treatment [20]. Minimal important change (MIC) in patients with forefoot disorders
Conclusion
Foot and ankle-specific PROMs such as SEFAS contribute with valuable information after HV surgery. Patients perceived normalized pain, function and Health related Quality of Life already within 6 months after surgery. The improvement between 6 and 24 months’ follow-up was minimal measured with PROMs.
Conflict of interest statement
The authors disclose that there were no conflicts to declare.
Financial support
Financial support was received from the Kalmar Regional Funds, Herman Järhardts stiftelse, Stiftelsen för Skobranschens utvecklingsfond, Kockska stiftelsen and Svenska Reumakirurgiska föreningen (SRK).
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2022, Foot and Ankle SurgeryCitation Excerpt :For example, after surgery, the return to sport varies from 78% to 100% depending on the series [4,16]. Results improve mainly during the first six months after surgery [17], but may take longer than two years in psychologically distress cases [18,19]. In addition, advanced age and high physical activity are other risk factors independent of disappointing results.
Preoperative photography improves patient satisfaction following hallux valgus surgery
2022, Foot and Ankle SurgeryCitation Excerpt :The desire for pain relief is often cited as the patient’s number one concern, but an improved appearance, and the ability to wear narrower shoes are the next most important factors [3,7,8]. Patients who undergo HV correction report diminished pain, improved function, and quality of life [9]. Patient satisfaction following HV surgery is between 73% and 94% [6,10–14], and a poor cosmetic result negatively impacts outcomes [6,15,16].
Effectiveness of hallux valgus surgery on improving health-related quality of life: A follow up study
2022, Foot and Ankle SurgeryCitation Excerpt :Their inclusion could provide valuable information for the evaluation of patients’ outcomes [33], and could play an important role in determining the impact of HV surgery on HRQoL. The correction of radiological angles is related to improvement in PROMs [29], although we observed a correction in the angles and poor scores in the PROMs, especially in the pain scoring. From this perspective, our data showed improvements after surgery in the three radiological angles (i.e., HVA, 1–2 IMA, and DMAA) similar to those previously reported in other studies [60,61].
The impact of hallux valgus on function and quality of life in females
2022, Foot and Ankle SurgeryCitation Excerpt :We believe the EQ-5D PROM should be used as a common standard in addition to the MOXFQ as it is more responsive than the generic SF-36 domains for patients with foot and ankle pathology [9,27]. The EQ-VAS score of 81.47 ± 14.8 in our HV cohort, is comparable to other studies reporting pre-operative EQ-VAS scores for HV deformity; Loveday et al. [32] reported a score of 83.5 ± 14.1 based on 32 patients with HV deformity whilst Nilsdotter et al. [33] reported a score of 76.1 based on 49 patients with HV deformity. This suggests our series is representative of patients presenting with HV deformity across a range of healthcare settings and populations.