Forecasting Posttreatment Outcome of Hallux Valgus Surgery Patients.
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ABSTRACT: Background
Despite advancements in operative techniques and the extraordinary number of procedures described for correcting hallux valgus (HV), there is still uncertainty as to why some patients thrive postoperatively whereas others do not. This study aimed to investigate whether the postoperative outcome of HV surgery could be predicted from patient demographics or functional impairment at the time of referral.Methods
The prospectively collected data, from 92 patients, were analyzed to determine whether patient demographics significantly influenced outcome 52 weeks after surgery. Potential relationships between socioeconomic deprivation and the outcome, as well as between preoperative functional impairment and postoperative improvement, were examined. The Manchester Oxford Foot Questionnaire (MOXFQ) and Scottish Index of Multiple Deprivation (SIMD) were used in this evaluation.Results
None of the demographics studied were found to be statistically significant determinants of outcome. Preoperative MOXFQ scores for patients from the most deprived areas were significantly worse at the time of referral. Patients living in the least deprived postcodes experienced the lowest improvement in MOXFQ scores. Patients from the most deprived SIMD quintile achieved significantly higher improvement in MOXFQ-walking and standing compared to those from the least deprived quintile. A strong positive correlation was found between the preoperative MOXFQ scores and the improvement in the scores postoperatively.Conclusion
In this patient cohort, demographics could not be used to predict the postoperative outcome at week 52. Socioeconomic disparities seem to influence the timing of patients seeking surgery. Lower preoperative MOXFQ scores strongly correlate with a lesser degree of postoperative improvement.Level of evidence
Level III, retrospective study with prospective arm.
SUBMITTER: Sawah A
PROVIDER: S-EPMC8446886 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics. The precise biomechanical etiology remains under debate. Predisposing factors include female sex, age, constricting footwear, and family history. Metatarsus adductus, equinus contracture, hammertoe deformity, and pes planus often coexist with hallux valgus. Nonoperative treatment involves patient education, shoe modifications, toe pads and positioning devices, and activity modifications. Surgery is considered in patients who fail nonoperative treatment with the goal of pain relief, correction of the deformity, improved first ray stability, and improved quality of life. More than 100 different procedures have been described to treat hallux valgus; they include combinations of soft tissue balancing, metatarsal osteotomies, and fusion of either the metatarsophalangeal (MTP) or tarsometatarsal (TMT) joint. The choice of procedures depends on the severity and location of the deformity as well as surgeon preference. Recent advances in operative techniques include minimally invasive surgery and correction of rotational deformity.
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Project description:There are many defined risk factors for wound healing. Comorbidities and their treatment are identified to be one of them. The aim of this study is to verify whether there are significant differences in wound healing between patients with and without systemic diseases, who underwent hallux valgus correction with Scarf osteotomy. A total of 155 consecutive patients were included into this prospective study. All of the patients underwent Scarf osteotomy for hallux valgus correction. In 60,6% of patients comorbidities were present, most often hypertension (57 patients, 36,8%), hypothyroidism (19 patients 12,3%) and diabetes (7 patients, 4,5%) occurred. Most of the patients were women (96,1%). During the study complication rate was noted. Patients underwent follow-up: 1,2, 3, 6 and 12 weeks and 6 months after the surgery. Preoperatively and during the last visit treatment results were assessed with AOFAS HMI scale. Scar assessment was performed by independent observer with VAS followed by patient scar assessment with VSS. In 30 patients complications were noted (19,4%). Surgical site infection was found in 6 patients (3,9%). In 13 patients (8,4%) partial wound dehiscence occurred, in 5 of them (3,2%) additional skin closure (Steri-Strips) was applied. Treatment results assessed with AOFAS HMI scale were good and very good in both healthy and comorbidity group, and the results improved significantly after surgical procedure. Scar assessment with VAS was on the average 1,5 pts. Average result in VSS was 2 pts. Results in both scales were rated as very good. No statistically significant differences were found in both healthy and comorbidity group in scar assessment. Based on the results of the study authors believe there are no significant differences between patients with and without comorbidities in aspects like: complication rate, surgery result and scar assessment as long as foot surgery is concerned.
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Project description:Introduction:The aim of this study was the evaluation of two different techniques on post-operative analgesia and motor recovery after hallux valgus correction in one-day surgery patients. Material and Methods:We enrolled 26 patients scheduled for hallux valgus surgery and treated with the same surgical technique (SCARF osteotomy). After subgluteal sciatic nerve block with a short acting local anaesthetic (Mepivacaine 1.5%, 15ml), each patient received an ultrasound-guided Posterior Tibialis Nerve Block (PTNB) with Levobupivacaine 0.5% (7-8ml). We measured the postoperative intensity of pain using a Visual Analogue Scale (VAS), the consumption of oxycodone after operative treatment and the motor recovery. VAS was detected at baseline (time 0, before the surgery) and at 3, 6, 12 and 24 hours after the operative procedure (T1, T2, T3, T4 respectively). Control group of 26 patients were treated with another post-operative analgesia technique: local infiltration (Local Infiltration Anaesthesia, LIA) with Levobupivacaine 0.5% (15ml) performed by the surgeon. Results:PTNB group showed a significant reduction of VAS score from the sixth hour after surgery compared to LIA group (p<0.028 at T2, p<0.05 at T3 and p<0.002 at T4, respectively). Instead, no significant differences were found in terms of post-operative oxycodone consumption and motor recovery after surgery.Conclusions: PTNB resulted in a valid alternative to LIA approach for post-operative pain control due to its better control of post-operative pain along the first 24 hours. In a multimodal pain management according to ERAS protocol, both PTNB and LIA should be considered as clinically effective analgesic techniques.
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Project description:BackgroundIn spite of recent advances in post-operative pain relief, pain following orthopedic surgery remains an ongoing challenge for clinicians. We examined whether a well known and frequently prescribed homeopathic preparation could mitigate post-operative pain.MethodWe performed a randomized, double blind, placebo-controlled trial to evaluate the efficacy of the homeopathic preparation Traumeel S in minimizing post-operative pain and analgesic consumption following surgical correction of hallux valgus. Eighty consecutive patients were randomized to receive either Traumeel tablets or an indistinguishable placebo, and took primary and rescue oral analgesics as needed. Maximum numerical pain scores at rest and consumption of oral analgesics were recorded on day of surgery and for 13 days following surgery.ResultsTraumeel was not found superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial, however a transient reduction in the daily maximum post-operative pain score favoring the Traumeel arm was observed on the day of surgery, a finding supported by a treatment-time interaction test (p = 0.04).ConclusionsTraumeel was not superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial. A transient reduction in the daily maximum post-operative pain score on the day of surgery is of questionable clinical importance.Trial registrationThis study was registered at ClinicalTrials.gov. # NCT00279513.
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Project description:BackgroundAlthough the etiology of hallux valgus is contested, in some patients it may be failure of the stabilizing soft tissue structures around the first ray of the foot. Because there is lack of effective soft tissue techniques, osteotomies have become the mainstream surgical approach to compensate for the underlying soft tissue deficiency; osteodesis, a soft tissue nonosteotomy technique, may be a third alternative, but its efficacy is unknown.Questions/purposesWe asked: (1) Can an osteodesis, a distal soft tissue technique, correct hallux valgus satisfactorily in terms of deformity correction and improvement in American Orthopaedic Foot and Ankle Society (AOFAS) score? (2) Is the effectiveness of an osteodesis affected by the patient's age or deformity severity? (3) What complications are associated with this procedure?MethodsBetween February and October 2010, we performed 126 operations to correct hallux valgus, of which 126 (100%) were osteodeses. Sixty-one patients (110 procedures) (87% of the total number of hallux valgus procedures) were available for followup at a minimum of 12 months (mean, 23 months; range, 12-38 months). This group formed our study cohort. During the study period, the general indications for this approach included failed conservative measures for pain relief and metatarsophalangeal angle greater than 20° or intermetatarsal angle greater than 9°. Intermetatarsal cerclage sutures were used to realign the first metatarsal and postoperative fibrosis was induced surgically between the first and second metatarsals to maintain its alignment. The radiologic first intermetatarsal angle, metatarsophalangeal angle, and medial sesamoid position were measured by Hardy and Clapham's methods for deformity and correction evaluation. Clinical results were assessed by the AOFAS score.ResultsThe intermetatarsal angle was improved from a preoperative mean of 14° to 7° (p<0.001; Cohen's d=1.8) at followup, the metatarsophalangeal angle from 31° to 18° (p<0.001; Cohen's d=3.1), the medial sesamoid position from position 6 to 3 (p<0.001; Cohen's d=2.4), and AOFAS hallux score from 68 to 96 points (p<0.001). Neither patient age nor deformity severity affected the effectiveness of the osteodesis in correcting all three radiologic parameters; however, the deformities treated in this series generally were mild to moderate (mean intermetatarsal angle, 14°; range, 9°-22°). There were six stress fractures of the second metatarsal (5%), five temporary metatarsophalangeal joint medial subluxations all resolved in one month by the taping-reduction method without surgery, and six metatarsophalangeal joints with reduced dorsiflexion less than 60°.ConclusionsThe osteodesis is a soft tissue nonosteotomy technique, and provided adequate deformity correction and improvement in AOFAS scores for patients with mild to moderate hallux valgus deformities, although a small number of the patients had postoperative stress fractures of the second ray develop. Future prospective studies should compare this technique with osteotomy techniques in terms of effectiveness of the correction, restoration of hallux function, complications, and long-term recurrence.Level of evidenceLevel IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Project description:Introduction:Hallux valgus surgery is one of the most commonly performed operations in Orthopaedics. Multiple surgical techniques have been described including arthrodesis, osteotomies and soft tissue procedures. The endoscopic-assisted distal soft tissue procedure is one of the minimally invasive surgical options with a good long-term outcome. The rehabilitation protocol for this soft tissue procedure consists of 6-weeks of non-weight bearing walking. This prolonged period of non-weight-bearing walking may ensure a good stabilization of the alignment but is difficult for the patient from a social-economical perspective. In addition, earlier mobilisation has other theoretical advantages including less atrophy and better range of motion. The objective of this trial is to investigate the effect of an earlier weight-bearing regime at 2-weeks post-surgery. Methods:Randomised control trial of patients undergoing the endoscopic-assisted distal soft tissue procedure. Allocation and randomization of subjects were performed immediately after completion of surgery to avoid intra-operative biases. The control group underwent the usual protocol of 6-weeks of non-weight-bearing walking while the intervention group underwent 2-weeks of post-operative non-weight-bearing walking. Foot function was measured using the Foot and Ankle Outcome Score (FAOS) at the baseline, 12-week post-surgery and 26-weeks post-surgery. The hallux valgus angle, 1,2 inter-metatarsal angle and tibial sesamoid position were also measured during those time-points. Results:A total of 51 participants completed the study, 29 in the control group and 22 in the early weight-bearing group. 1 patient form the early weight-bearing group was complicated with hallux varus requiring revision surgery. All the patients had significantly improved radiological angles and foot function in both the control and early weight-bearing group. At the 12-week time point, the radiological angles were the same for both groups but foot function was significantly better in the early weightbearing group. Discussion:Early postoperative weight-bearing did not lead to pre-mature implant failures or increased recurrence rates. It actually resulted in fewer symptoms like stiffness, lessened pain, better performance in daily activities and a better quality of life. Conclusion:Early weight-bearing walking at 2-week after distal soft tissue reconstruction of hallux valgus is not only safe, it may help accelerate the rehabilitation process and allow patients to return their usual life faster.The translational potential of this article: Being a clinical trial, our results are directly translatable to hallux valgus patients. The results of this study show that a shortened non-weight bearing duration after hallux valgus surgery improves foot function at 12 weeks while not affecting recurrence risks.
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Project description:Background and purpose - The quality of life (QoL) of patients with hallux valgus (HV) usually improves postoperatively. Evidence regarding the effect of HV surgery on different domains of patient QoL remains inconclusive. This systematic review and meta-analysis estimates the effect of HV surgery on patient QoL through distinguishing effects on physical domains (comprising physical function and body pain domains) using the EuroQol-5D, short form (SF) health survey-12, and SF-36 QoL scales and a visual analogue scale (VAS) score and mental and social domains using QoL scales.Patients and methods - MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2019 for studies on the effect of HV surgery on patient QoL. A standardized mean difference score was calculated for each specific QoL domain (mental, social, pain, physical, and VAS) using Cohen's d index. The pooled effect size (ES) was estimated using a random-effects model based on the DerSimonian and Laird method.Results - From 12 published studies selected, the estimated pooled ES for QoL was 1.01 (95% confidence interval [CI] 0.52-1.51; I2 = 87%) for body pain and 0.43 (CI 0.31-0.55, I2 = 35%) for physical function. Regarding the composite mental and social domains of QoL, the pooled ES estimates were 0.24 (CI 0.00-0.47, I2 = 80%) and 0.42 (CI 0.21-0.63, I2 = 6.4%), respectively. The pooled difference in means for the VAS score was -4.1 (CI -4.5 to -3.6, I2 = 90%).Interpretation - Our data showed that HV surgery decreased patients' perceptions regarding pain. Furthermore, the data confirmed that HV surgery increased patients' QoL, particularly concerning physical and social domains.
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Project description:Recurrence is a frequent and undesirable outcome after hallux valgus (HV) surgery. However, the prevalence of HV recurrence and the pre- and postoperatory factors associated with it have not been adequately studied. This study aimed to quantify the prevalence rate of HV recurrence and to analyze its predisposing factors. MEDLINE and EMBASE databases were systematically searched for observational studies including individuals undergoing HV surgical correction. The random-effects restricted maximum likelihood model was used to estimate the pooled effect size (correlation coefficient (r)). Twenty-three studies were included, yielding a total of 2914 individuals. Pooled prevalence of HV recurrence was 24.86% (95% confidence interval (CI), 19.15 to 30.57, I2 = 91.92%, p = 0.00). Preoperative HV angle (HVA) (r = 0.29; 95% CI, 0.14 to 0.43) and preoperative intermetatarsal angle (IMA) (r = 0.13; 95% CI, 0.00 to 0.27) showed a moderate positive relationship with recurrence. Postoperative HVA (r = 0.57; 95% CI, 0.21 to 0.94) and sesamoid position (r = 0.46; 95% CI, 0.31 to 0.60) showed strong relationships with recurrence. In conclusion, preoperative HVA, IMA, and postoperative HVA and sesamoid position are significant risk factors for HV recurrence, and the association of these factors with recurrence is affected by age.
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Project description:BackgroundHallux valgus (HV) has been linked to functional disability and increased falls risk in older adults. However, specific gait alterations in individuals with HV are unclear. This systematic review investigated gait parameters associated with HV in otherwise healthy adults.MethodsElectronic databases (Medline, Embase, CINAHL) were searched to October 2011, including cross-sectional studies with clearly defined HV and non-HV comparison groups. Two investigators independently rated studies for methodological quality. Effect sizes (95% confidence intervals (CI)) were calculated as standardized mean differences (SMD) for continuous data and risk ratios (RR) for dichotomous data.ResultsNine studies included a total of 589 participants. Three plantar pressure studies reported increased hallux loading (SMD 0.56 to 1.78) and medial forefoot loading (SMD 0.62 to 1.21), while one study found reduced first metatarsal loading (SMD -0.61, CI -1.19 to -0.03) in HV participants. HV participants demonstrated less ankle and rearfoot motion during terminal stance (SMD -0.81 to -0.63) and increased intrinsic muscle activity (RR 1.6, 1.1 to 2.2). Most studies reported no differences in spatio-temporal parameters; however, one study found reduced speed (SMD -0.73, -1.25 to -0.20), step length (SMD -0.66 to -0.59) and less stable gait patterns (SMD -0.86 to -0.78) in older adults with HV.ConclusionsHV impacts on particular gait parameters, and further understanding of potentially modifiable factors is important for prevention and management of HV. Cause and effect relationships cannot be inferred from cross-sectional studies, thus prospective studies are warranted to elucidate the relationship between HV and functional disability.
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Project description:BackgroundThe severity of hallux valgus is easily appreciated by its clinical appearance, however x-ray measurements are also frequently used to evaluate the condition, particularly if surgery is being considered. There have been few large studies that have assessed the validity of these x-ray observations across a wide spectrum of the deformity. In addition, no studies have specifically focused on older people where the progression of the disorder has largely ceased. Therefore, this study aimed to explore relationships between relevant x-ray observations with respect to hallux valgus severity in older people.MethodsThis study utilised 402 x-rays of 201 participants (74 men and 127 women) aged 65 to 94 years. All participants were graded using the Manchester Scale - a simple, validated system to grade the severity of hallux valgus - prior to radiographic assessment. A total of 19 hallux valgus-related x-ray observations were performed on each set of x-rays. These measurements were then correlated with the Manchester Scale scores.ResultsStrong, positive correlations were identified between the severity of hallux valgus and the hallux abductus angle, the proximal articular set angle, the sesamoid position and congruency of the first metatarsophalangeal joint. As hallux valgus severity increased, so did the frequency of radiographic osteoarthritis of the first metatarsophalangeal joint and a round first metatarsal head. A strong linear relationship between increased relative length of the first metatarsal and increased severity of hallux valgus was also observed.ConclusionsStrong associations are evident between the clinical appearance of hallux valgus and a number of hallux valgus-related x-ray observations indicative of structural deformity and joint degeneration. As it is unlikely that metatarsal length increases as a result of hallux valgus deformity, increased length of the first metatarsal relative to the second metatarsal may be a contributing factor to the development and/or progression of hallux valgus.
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