1
|
Shibuya N, Agarwal MR, Jupiter DC. A New Paradigm in Foot and Ankle Outcomes?: Away From Radiographs and Toward Patient-Centered Outcomes. Clin Podiatr Med Surg 2024; 41:259-268. [PMID: 38388122 DOI: 10.1016/j.cpm.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Having reasonable outcome measures is essential to unbiased research. For years, provider-measured outcomes have been valued as they are more objective and convenient for investigators. However, with the popularity of patient-centered medical care delivery, patient-reported outcome measures are appropriately becoming more popular in foot and ankle research.
Collapse
Affiliation(s)
- Naohiro Shibuya
- University of Texas Rio Grande Valley, School of Podiatric Medicine.
| | - Monica R Agarwal
- University of Texas Rio Grande Valley, School of Podiatric Medicine
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2101 Treasure Hills Boulevard, Harlingen, TX 78550, USA
| |
Collapse
|
2
|
Motta LM, Manchado I, Blanco G, Quintana-Montesdeoca MP, Garcés L, Garcés GL. Cross-cultural adaptation and validation of a Spanish version of the self-administered foot evaluation questionnaire (SAFE-Q). J Orthop Sci 2024; 29:627-631. [PMID: 36914484 DOI: 10.1016/j.jos.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/11/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The self-administered foot evaluation questionnaire is a comprehensive measure for assessing the perception of patients regarding their foot-related problems. However, it is currently only available in English and Japanesse. Therefore, this study aimed to cross-culturally adapt the questionnaire to Spanish and assess its psychometric properties. METHODS The methodology recommended by the International Society for Pharmaco Economics and Outcomes Research for translating and validating patient-reported outcome measures was followed for the Spanish translation. After a pilot study with 10 patients and 10 controls, an observational study was carried out between March and December 2021. The Spanish version of the questionnaire was filled by 100 patients with unilateral foot disorders, and the time spent to complete each questionnaire was recorded. Cronbach's alpha was calculated to analyze the internal consistency of the scale and Pearson's correlation coefficients for the degree of inter-subscale associations. RESULTS The maximum correlation coefficient for the Physical Functioning, Daily Living, and Social Functioning subscales was 0.768. The inter-subscale correlation coefficients were significant (p < 0.001). Additionally, the value of Cronbach's alpha for the whole scale was 0.894 (95% confidence interval, 0.858-0.924). The values of Cronbach's alpha varied between 0.863 and 0.889 when the value of one of the five subscales was suppressed, which can be considered a measure of good internal consistency. CONCLUSION The Spanish version of the questionnaire is valid and reliable. The method followed for its transcultural adaptation ensured its conceptual equivalence with the original questionnaire. Health practitioners can use the self-administered foot evaluation questionnaire as a complementary method to assess the interventions performed for ankle and foot disorders among native Spanish speakers; however, further research is necessary to assess its consistency for use by populations from other Spanish-speaking countries.
Collapse
Affiliation(s)
- Luci M Motta
- Hospital Perpetuo Socorro Calle León y Castillo 407, 35007 Las Palmas Spain; University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Ignacio Manchado
- Hospital Perpetuo Socorro Calle León y Castillo 407, 35007 Las Palmas Spain; University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Gustavo Blanco
- Hospital Perpetuo Socorro Calle León y Castillo 407, 35007 Las Palmas Spain
| | | | - Laura Garcés
- Terapias Acuáticas Canarias SL, Las Palmas Spain
| | - Gerardo L Garcés
- Hospital Perpetuo Socorro Calle León y Castillo 407, 35007 Las Palmas Spain; University of Las Palmas de Gran Canaria, Las Palmas, Spain.
| |
Collapse
|
3
|
Archer H, Reine S, Ramachandran S, Koay J, Liu G, Wukich DK, Chhabra A. Correlation Between Traditional Anteroposterior Radiographic Measurements With Lateral Radiographic Measurements Following Triplanar Correction of Hallux Valgus and With Patient-Reported Outcomes From a Prospective Multicenter Trial. J Foot Ankle Surg 2024; 63:226-232. [PMID: 37984694 DOI: 10.1053/j.jfas.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Hallux valgus (HV) is a common condition in which the first ray is deformed, leading to pain and altered joint mechanics. A variety of radiographic measurements are used to evaluate HV. Little is known about measurements used in the assessment of HV on lateral radiographs compared to anteroposterior (AP) radiographs. The primary aim of this study was to correlate lateral measurements with AP measurements pre and postoperatively. The secondary aim was to correlate lateral measurements with patient-reported outcome measures (PROMs) pre and postoperatively. One hundred eighty-three patients were initially enrolled in the study. Two fellowship-trained musculoskeletal radiologists independently performed all measurements. On AP radiographs, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. On lateral radiographs, sagittal IMA, Meary's angle, and sagittal first ray length were measured. Measurements were recorded at baseline and 6, 12, and 24 months postoperatively. Intraclass correlation coefficients (ICCs) were used for inter-reader analysis. ICCs were moderate to very strong among readers. There were significant but weak correlations between lateral measurements and AP measurements. For at least 1 timepoint, IMA correlated with sagittal IMA, sagittal first ray length, and Meary's angle. HVA only correlated with sagittal first ray length. These correlations were all weak in magnitude. There were a few significant but weak correlations between the measurements in the study and PROMs. This study showed that sagittal IMA, sagittal first ray length, and Meary's angle are not predictive of AP measurements or patient outcomes and are not useful in preoperative assessment of HV.
Collapse
Affiliation(s)
- Holden Archer
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Seth Reine
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - George Liu
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Avneesh Chhabra
- University of Texas Southwestern Medical Center, Dallas, TX.
| |
Collapse
|
4
|
Ramachandran SS, Reine S, Archer H, Koay J, Wukich DK, Chhabra A. Interreader reliability assessment of hallux valgus evaluation on dorsoplantar weightbearing radiographs from a prospective multi-center trial and correlation with patient-reported outcome measures. Skeletal Radiol 2023; 52:2419-2425. [PMID: 37199757 DOI: 10.1007/s00256-023-04365-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To determine inter-reader reliability (IRR) of hallux valgus (HV) related parameters, i.e. intermetatarsal angle (IMA), hallux valgus angle (HVA), lateral round sign of the first metatarsal, tibial sesamoid position (TSP), metatarsus adductus angle (MAA), transverse osseous foot width, 1st MT length, MTP osteoarthritis (OA), and distal metatarsal articular angle (DMAA). These were correlated with patient-reported outcome measures (PROMs). MATERIALS AND METHODS A prospective single-arm Level 3 multicenter clinical trial in which standardized radiographs and PROMs were collected at the time of the initial patient visit for pre-operative assessment. Two musculoskeletal radiologists performed measurements blinded to each other's reads and clinical information. Intraclass coefficient and kappa were obtained for inter-reader analysis. A partial spearman rank order was used to correlate the measurements with PROMs. RESULTS The final cohort size of 183 patients had mean age of 40.77 years, mean body mass index was 26.11 kg/m2, with 91.2% females and 8.7% males. There was excellent IRR for HVA (0.96, CI: [0.94,0.97]), IMA (0.92, CI: [0.89,0.94]), transverse osseous foot width (0.99, CI: [0.98,1.00]), and DMAA (0.80, CI: [0.74, 0.85]), good agreement for TSP (0.73, CI:[0.67,0.79]) and MAA (0.67, CI: [0.16, 0.84]), fair agreement for MTP OA (0.48, CI: [0.36,0.59]), and poor agreement for lateral round sign (0.32, CI: [0.11, 0.52]. The negative correlation of increasing transverse osseous foot width with worsening PROMIS physical but better MOxFQ and VAS scores is likely spurious. CONCLUSION Good to excellent inter-reader reliability was observed for the most often used measurements for HV assessment without major trends in their correlations with PROMs. Lateral round sign is not a reliable finding in HV deformity.
Collapse
Affiliation(s)
- Shyam S Ramachandran
- Texas A&M School of Medicine, Dallas, TX, USA
- Department of Orthopaedic Surgery, UT Southwestern, Dallas, TX, 75390-9178, USA
| | - Seth Reine
- Department of Orthopaedic Surgery, UT Southwestern, Dallas, TX, 75390-9178, USA
| | - Holden Archer
- Department of Orthopaedic Surgery, UT Southwestern, Dallas, TX, 75390-9178, USA
| | | | - Dane K Wukich
- Department of Orthopaedic Surgery, UT Southwestern, Dallas, TX, 75390-9178, USA
| | - Avneesh Chhabra
- Department of Orthopaedic Surgery, UT Southwestern, Dallas, TX, 75390-9178, USA.
- Department of Radiology, UT Southwestern, Dallas, TX, USA.
- Johns Hopkins University, Maryland, MD, USA.
- University of Dallas, Richardson, TX, USA.
- Walton Centre for Neuroscience, Liverpool, UK.
| |
Collapse
|
5
|
Nishikawa DRC, Duarte FA, Saito GH, de Miranda BR, Pontin PA, Mendes AAM, Prado MP. Impact of forefoot width variation on clinical and functional outcomes following the Lapidus procedure. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2853-2858. [PMID: 36871250 DOI: 10.1007/s00590-023-03506-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE This study aimed to evaluate the effect of variations in bony and soft tissue foot widths on clinical and functional outcomes after hallux valgus correction with the Lapidus procedure. METHODS Forty-three feet in 35 patients with a mean follow-up of 18.5 months undergoing the LP were reviewed. Clinical and functional data were assessed with the VAS for pain, AOFAS Scale, LEFS and SF-12 health survey, which is divided into physical and mental health composite scales (PCS-12 and MCS-12). Radiographic analysis of forefoot width was based on bony and soft tissue limits. Intermetatarsal-angle and HV-angle were also assessed. RESULTS Bony width changed significantly from 95.5 mm to 84.2 mm (11.8%) and soft tissue width from 107.12 mm to 100.84 mm (5.86%) (p < 0.001). IMA and HVA improved significantly. Significant clinical and functional improvements were observed, except in MCS-12. In simple linear regression, correlation was found between variations of bony width with Δ-AOFAS and Δ-PCS-12, meaning that as the forefoot narrows, their values increase (p = 0.02 and p = 0.005, respectively). It was also related to Δ-IMA, meaning that the forefoot narrows as these parameters improve (p < 0.001 and p < 0.001). Soft tissue width was related to Δ-PCS-12 and Δ-AIM. In multiple linear regression, the strongest correlation was between bony width variation and Δ-IMA (p = 0.029, r2 = 0.22). CONCLUSION Forefoot narrowing was correlated with improved clinical and functional outcomes, as measured by AOFAS and PCS-12. In addition, correction of the radiographic parameters, mainly IMA, reflected on a significant decrease in the forefoot width.
Collapse
Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, São Paulo, SP, CEP: 01532-000, Brazil.
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil.
- Department of Orthopaedic Surgery, Care Club, 4615, Brigadeiro Luís Antônio Avenue, Jardim Paulista, São Paulo, SP, CEP 01401-002, Brazil.
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil
- Department of Orthopaedic Surgery, Care Club, 4615, Brigadeiro Luís Antônio Avenue, Jardim Paulista, São Paulo, SP, CEP 01401-002, Brazil
| | - Guilherme Honda Saito
- Department of Orthopaedic Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, São Paulo, SP, CEP: 01308-050, Brazil
| | - Bruno Rodrigues de Miranda
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, São Paulo, SP, CEP: 01532-000, Brazil
| | - Pedro Augusto Pontin
- Department of Orthopaedic Surgery, Care Club, 4615, Brigadeiro Luís Antônio Avenue, Jardim Paulista, São Paulo, SP, CEP 01401-002, Brazil
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| |
Collapse
|
6
|
Shibuya N. "I Want My Bunion Back" 10 Years Later in the Era of Patient-Reported Outcomes. J Foot Ankle Surg 2023; 62:755. [PMID: 37652639 DOI: 10.1053/j.jfas.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Naohiro Shibuya
- Clinical Professor, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX.
| |
Collapse
|
7
|
Chodaba Y, Andrews NA, Halstrom J, Sankey T, Sanchez T, Harrelson WM, Agarwal A, Shah A. First Metatarsophalangeal Arthrodesis for Hallux Rigidus and Hallux Valgus: A Comparison of Patient Reported and Clinical Outcomes. J Foot Ankle Surg 2023:S1067-2516(23)00036-4. [PMID: 36964117 DOI: 10.1053/j.jfas.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 03/26/2023]
Abstract
Few prior studies have compared the patient reported outcomes of first metatarsophalangeal arthrodesis between hallux rigidus and hallux valgus patients. Furthermore, we sought to examine the impact of postoperative radiographic hallux alignment on outcomes scores within each group. A retrospective review of 98 patients who a received primary metatarsophalangeal arthrodesis from January 2010 to March 2020. Clinical complications including nonunion were collected. Patient Reported Outcomes Measurement Information Systems (PROMIS) Physical Function, PROMIS Pain Interference, and the foot function index (FFI) revised short form scores were obtained via telephone. Patients were grouped based on review of preoperative radiographs of the foot and this grouping 37 hallux rigidus and 61 hallux valgus patients. Clinical and patient reported outcomes were compared between these pathologies. No differences in the rate of wound complications, radiographic union, and revision surgery were found between the 2 subgroups. At a median of 2.4 years (3.9 IQR) postoperatively, PROMIS and FFI scores did not vary by pathology group. For both groups, PROMIS scores were similar to the general population of the United States. The postoperative first MTP dorsiflexion angle in the hallux rigidus group was correlated with decreased FFI Pain, FFI Total, and PROMIS Pain Interference domain scores (|r| ≥ 0.40, p < .05 for all). When performing MTP arthrodesis in patients with hallux rigidus, increasing the first MTP dorsiflexion angle may correlate with improved intermediate term patient reported outcomes. However, further studies will need to be done to confirm this theoretical relationship.
Collapse
Affiliation(s)
- Yvonne Chodaba
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jared Halstrom
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Turner Sankey
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas Sanchez
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Whitt M Harrelson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Abhinav Agarwal
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
| |
Collapse
|
8
|
Investigation on the site of coronal deformities in Hallux valgus. Sci Rep 2023; 13:1815. [PMID: 36725901 PMCID: PMC9892504 DOI: 10.1038/s41598-023-28469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/18/2023] [Indexed: 02/03/2023] Open
Abstract
Hallux valgus (HV) is a common foot deformity that is more prevalent in females, characterised by abnormal adduction of the first metatarsal (MT) and valgus deviation of the phalanx on the transverse plane. Increasing evidence indicates that HV is more than a 2D deformity but a 3D one with rotational malalignment. Pronation deformity is seen during clinical examination for HV patients, but the exact origin of this rotational deformity is still unknown. Some attribute it to first tarsometatarsal (TMT) joint rotation, while others attribute it to intra-metatarsal bony torsion. In addition, the correlation between the rotational and transverse plane deformity is inconclusive. Identifying the origin of the rotational deformity will help surgeons choose the optimal surgical procedure while also enhancing our understanding of the pathophysiology of HV. This study aims to (1) develop an objective method for measuring the first MT torsion and first TMT joint rotation; (2) investigate the exact location of the coronal deformity in HV; (3) investigate the relationship between the severity of deformity on the transverse and coronal planes as well as the correlation between deformity severity and foot function/symptoms in HV. Age-matched females with and without HV were recruited at the Foot and Ankle Clinic of the Department of Orthopaedics and Traumatology. Computed tomography was conducted for all subjects with additional weight-bearing dorsal-plantar X-ray examination for HV subjects. Demographic information of all subjects was recorded, with symptoms and functions related to HV evaluated. The intra-class correlation was used to explore the relationship between deformities on different planes and the deformity severity and functional outcomes, respectively. An Independent t-test was used to compare joint rotation and bone torsion degrees. TMT joint rotation is significantly correlated with foot function. HV patients had more TMT joint rotation but not MT torsion compared to normal controls. No relationship was found between the coronal rotation and the 1,2-intermetatarsal angle (IMA) or Hallux valgus angle (HVA) on the transverse plane. Our results indicate that coronal deformities in HV may originate from TMT joint rotation. In addition, the severity of the TMT joint coronal rotation correlates with worse foot function; thus, multi-plane assessment and examination will be necessary for more precise surgical correction.
Collapse
|
9
|
Bello-Tejeda LL, Perez-Aznar A, Sebastia-Forcada E, Miralles-Muñoz FA, Lizaur-Utrilla A, Vizcaya-Moreno MF. Sesamoid Position Change Over 2 Years After Distal Chevron Osteotomy for Moderate to Severe Hallux Valgus: A Prospective Cohort Study. Foot Ankle Int 2023; 44:95-103. [PMID: 36692127 DOI: 10.1177/10711007221146192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Sesamoid position change after distal chevron osteotomy for moderate to severe hallux valgus is not well known in the literature. The objective of this study was to determine whether the sesamoid position changed over 2 years after distal chevron osteotomy for moderate to severe hallux valgus. METHODS Ninety-seven patients who underwent distal chevron osteotomy for moderate to severe hallux valgus were prospectively assessed for 2 years. There were 91 females, and the mean age was 54.9 (SD 10.9) years. The Self-Reported Foot and Ankle Score (SEFAS) was used for functional assessment. Foot pain was assessed by a 0-10 visual analog scale (VAS), and patient satisfaction by a 5-point Likert scale. Radiologically, hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), metatarsal head displacement, and sesamoid position by the AOFAS criteria were analyzed. Patients were classified according to the medial sesamoid position on the first postoperative weightbearing radiograph (1º-WB-Xray) into the reduced sesamoid group (66 patients) and nonreduced sesamoid group (31 patients). RESULTS All patients were assessed preoperatively and postoperatively at 1 month and 2 years. On the 1º-WB-Xray, IMA was significantly lower in the reduced group (P = .038), but HVA (P = .063) and DMAA (P = .246) were not significantly different. At the final follow-up, no patients in the reduced group had sesamoid position change from 1º-WB-Xray, whereas 8 (25.8%) patients in the nonreduced group had change of their sesamoid positions. The SEFAS was not significantly different between groups preoperatively (P = .386) or at 1 month postoperation (P = .064). The final SEFAS, VAS pain, and satisfaction scores were significantly better in the reduced group, although the clinical significance of these changes remains unknown. CONCLUSION A nonreduced position of the sesamoids obtained in surgery can cause their increased malposition over 2 postoperative years and statistically less functional outcomes. LEVEL OF EVIDENCE Level II, prospective cohort study.
Collapse
Affiliation(s)
| | - Adolfo Perez-Aznar
- Department of Orthopaedic Surgery. Eldas University Hospital, Elda, Alicante, Spain
| | | | | | - Alejandro Lizaur-Utrilla
- Department of Traumatology and Orthopaedics. Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
| | - M Flores Vizcaya-Moreno
- Unit of Research, Faculty of Health Sciences, University of Alicante, San Vicente Raspeig, Alicante, Spain
| |
Collapse
|
10
|
Albright R, Klein E, Baker J, Sorensen M, Weil L, Fleischer A. Are Radiographs Associated With Patient Satisfaction After Scarf Bunionectomy? J Foot Ankle Surg 2022; 62:2-6. [PMID: 35705454 DOI: 10.1053/j.jfas.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 02/03/2023]
Abstract
There are over 350,000 bunion surgeries performed in the USA annually, making it one of the most common elective forefoot surgeries. Studies have suggested that as many as 10% of patients remain dissatisfied after bunion surgery. The purpose of this study is to evaluate if radiographic variables are associated with patient satisfaction at 1 year postoperatively. We performed a secondary analysis of prospectively collected data on 69 consecutive adult patients (mean age 45 ± 14 years, 91% female [63/69]) who underwent isolated hallux valgus surgery from January 2016 to January 2017. Subjects completed a standardized 4-item survey inquiring about their satisfaction with regards to pain relief, overall operative result, cosmetic appearance, and ability to wear desired shoe gear. Conventional radiographic indices for hallux valgus were examined preoperatively and 3 months postoperatively. An association model using backward stepwise logistic regression was utilized to determine which variables, if any, are most important in explaining patient satisfaction after surgery. Sixty-nine subjects completed the 4-item satisfaction survey with 53.6% (37/69) of subjects answering they were fully satisfied on all aspects of the survey at 12 months postoperatively. In the final regression model, no radiographic or demographic variables were associated with patient satisfaction including shoe gear, cosmetic appearance, pain relief, and overall operative result. Radiographic variables did not appear to be associated with patient satisfaction at one year postoperatively in our study. Factors such as quality of life, anxiety levels, fear of surgery, and/or preoperative expectations may offer more insight into satisfaction; however, further research should be performed to examine this further.
Collapse
Affiliation(s)
- Rachel Albright
- Podiatrist, Department of Surgery, Stamford Health Medical Group, Stamford, CT.
| | - Erin Klein
- Associate Director of Research, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Jeffrey Baker
- Partner, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Matthew Sorensen
- Fellowship Director, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Lowell Weil
- CEO, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Adam Fleischer
- Director of Research, Weil Foot & Ankle Institute, Mount Prospect, IL; Professor, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| |
Collapse
|
11
|
Blouin C, Genet F, Denormandie P, Graff W, Perrier A. Development of a preoperative questionnaire to improve satisfaction with hallux valgus repair: A Delphi study. PLoS One 2022; 17:e0276303. [PMID: 36279269 PMCID: PMC9591061 DOI: 10.1371/journal.pone.0276303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Satisfaction with hallux valgus repair is often poor, despite good surgical outcomes. Many tools have been developed to assess the outcome of the procedure; however none evaluate the association between the initial motive for repair and the reasons for post-surgical dissatisfaction. The aim of this study was to develop a new tool to analyse the subjective and objective expectations of individuals during a pre-operative consultation for hallux valgus repair in order to improve post-surgical satisfaction. METHODS We first collected the reasons for dissatisfaction with repair from the medical files of dissatisfied individuals. Then, a steering committee of 4 French experts in the management of hallux valgus designed a questionnaire based on the reasons for dissatisfaction. We then used the DELPHI method to validate the questionnaire: we submitted the questionnaire to a panel of 34 francophone experts in hallux valgus repair for rating in 4 rounds. RESULTS The medical files of 853 individuals were reviewed and a 52-item questionnaire relating to expectations from hallux valgus surgery was drafted. After the 4 rounds, a final 44 item questionnaire reached consensus. Thirteen items related to clinical and psychological profile, 5 to pain, 9 to physical activity, 4 to aesthetics and 13 to footwear. CONCLUSION This tool should facilitate gathering of individuals' expectations from hallux valgus repair to ensure realistic goals and reduce post-surgical dissatisfaction.
Collapse
Affiliation(s)
- Cédric Blouin
- UFR Simone Veil-Santé, UR2020 Erphan, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- ISPC Synergies, Paris, France
- * E-mail:
| | - François Genet
- ISPC Synergies, Paris, France
- Département PARASPORT-SANTE, Unité Péri Opératoire du Handicap, (UPOH-Perioperative Disability Unit), Service de Médecine Physique et de Réadaptation, Hôpital Raymond-Poincaré, Groupe Hospitalo-Universitaire APHP-Université PARIS SACLAY, Garches, France
- UFR Simone Veil-Santé, END: ICAP, Inserm U1179, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
| | - Philippe Denormandie
- Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, APHP, Garches, France
- Groupe Mutuelle Nationale des Hospitaliers (MNH), Paris, France
| | - Wilfrid Graff
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
| | - Antoine Perrier
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- Laboratoire de Recherche Translationnelle et D’Innovation en Médecine et Complexité TIMC, CNRS, Grenoble, France
- Service de Diabétologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| |
Collapse
|
12
|
Rajan L, Kim J, An T, Fuller R, Zhu J, Pinney SJ, Ellis SJ. The influence of concomitant hammertoe correction on postoperative outcomes in patients undergoing hallux valgus correction. Foot Ankle Surg 2022; 28:1100-1105. [PMID: 35346594 DOI: 10.1016/j.fas.2022.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/13/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with hallux valgus often develop secondary hammertoe deformities of the lesser toes. Operative management of bunions with hammertoe can be more extensive; however, it is unclear whether this affects patient-reported outcomes. The aim of this study was to compare postoperative patient-reported outcome measures and radiographic outcomes between patients who underwent isolated bunion correction and patients who underwent simultaneous bunion and hammertoe correction. METHODS Preoperative, postoperative, and change in Patient-Reported Outcomes Measurement Information System (PROMIS) scores were compared between patients who underwent isolated hallux valgus correction and those who underwent concomitant hammertoe correction. Radiographic measures including hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal-articular angle (DMAA), and Meary's angle were also compared. Targeted minimum-loss estimation (TMLE) was used for statistical analysis to control for confounders. RESULTS A total of 221 feet (134 isolated bunion correction, 87 concomitant hammertoe correction) with a minimum of 12 months follow-up were included in this study. Both cohorts demonstrated significant improvements in the physical function, pain interference, pain intensity, and global physical health PROMIS domains (all p < 0.001). However, patients in the concomitant hammertoe cohort had significantly less improvements in pain interference and pain intensity (p < 0.01, p < 0.05 respectively). The concomitant hammertoe cohort also had significantly higher postoperative pain interference scores than the isolated bunion cohort (p < 0.01). Radiographic outcomes did not differ between the two groups. CONCLUSION While both isolated bunion correction and concomitant hammertoe correction yielded clinically significant improvements in patient reported outcomes and normalized radiographic parameters, patients undergoing simultaneous bunion and hammertoe correction experienced substantially less improvement in postoperative pain-related outcomes than those who underwent isolated bunion correction.
Collapse
Affiliation(s)
- Lavan Rajan
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Jaeyoung Kim
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Tonya An
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Robert Fuller
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Jiaqi Zhu
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Stephen J Pinney
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Scott J Ellis
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
| |
Collapse
|
13
|
Klein EE, Wirt C, Greenley R, Weil LS, Weil L, Fleischer AE. Do Patient Personality Traits and Self-Reported Physical and Psychosocial Symptoms Help to Predict Hallux Valgus Surgery Outcomes? J Foot Ankle Surg 2022; 61:950-956. [PMID: 34998678 DOI: 10.1053/j.jfas.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/07/2021] [Indexed: 02/03/2023]
Abstract
As many as 10% of patients remain unsatisfied after hallux valgus surgery. We explored the effects of patient personality traits and other preoperative patient characteristics on patient-reported outcomes following surgery. Eighty consecutive adult patients (mean age 45 ± 14 years, 91% female [73/80]) undergoing scarf bunionectomy at our practice were prospectively enrolled from January 2016 to January 2017 and followed for 12 months. Predictor variables included preoperative physical and psychosocial complaints (determined via Brief Battery for Health Improvement-2 questionnaire), patient aggression level, and personality traits (extraversion, agreeableness, conscientiousness, emotional stability and openness). Primary outcome measures included the Foot and Ankle Outcome Score (FAOS) with its 5 subscales, and patient satisfaction. Multiple multivariable regression models were used to determine preoperative patient characteristics associated with FAOS outcome and satisfaction at 12 months. Seventy subjects (70/80, 87.5%) completed the study. All patients experienced technically successful surgery. In the multivariable regression analyses, none of the combinations of potentially important predictor variables explained more than 19.8% of the variance in any of the 5 FAOS subscales at 12 months (range: 6.1%-19.8%). Furthermore, no predictor was associated with patient satisfaction in either the univariate or multivariable analyses. We conclude that patient personality traits, aggression level, and self-reported physical and psychological symptoms do very little to predict outcomes in hallux valgus surgery. As healthcare delivery in the United States has increasingly prioritized patient satisfaction, we will need to broaden the quest for predictors associated with our best (and worst) patient-reported outcomes after hallux valgus surgery.
Collapse
Affiliation(s)
- Erin E Klein
- Associate Director of Research, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Craig Wirt
- Podiatrist, Northwestern Medicine Orthopaedics, Warrenville, IL
| | - Rachel Greenley
- Professor and Chair, Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Lowell S Weil
- Founder, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Lowell Weil
- CEO, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Adam E Fleischer
- Director of Research, Weil Foot & Ankle Institute, Mount Prospect, IL; Professor, Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL.
| |
Collapse
|
14
|
Clee S, Flanagan G, Pavier J, Reilly I. Correction of hallux abducto valgus by scarf osteotomy. A ten-year retrospective multicentre review of patient reported outcomes shows high satisfaction rates with podiatric surgery. J Foot Ankle Res 2022; 15:44. [PMID: 35650635 PMCID: PMC9159929 DOI: 10.1186/s13047-022-00546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Corrective surgery for hallux abducto valgus is one of the most performed elective procedures in foot and ankle practice. Numerous methods of surgical correction have been reported within the literature, with varying clinical and patient reported outcomes. This study reviews the patient experience and outcomes in five podiatric surgery centres using the scarf diaphyseal osteotomy. METHOD Patient reported outcome measures (PROMs) were captured using the Patient Satisfaction Questionnaire 10 (PSQ-10), part of the PASCOM-10 podiatric surgery audit tool. PROMs were collated across five hospital sites over a 10-year period. RESULTS Of 1351 patients reported during the period, 1189 had complete retrospective data. The most common patient aim of surgery was 'no/less pain' reported in 70% of patients. 96.8% of patients reported their original foot complaint as 'better' or 'much better' after surgery. 92.8% of patients reported their expectations had been met with 96.6% reporting they would have surgery again under the same conditions. 98.5% of patients noted that the risks, complications, and expectations had been discussed prior to surgery. The most common complication was metatarsal fracture (4.6%). CONCLUSION The scarf osteotomy (with or without an Akin phalangeal osteotomy) consistently showed high patient satisfaction with low complication rates using PSQ-10 and this information can be used as part of the pre-operative consenting process. Patient expectations for surgery were often achieved, which may be attributed to the pre-operative work up of the patient. Further investigation into this correlation is suggested. LEVEL OF CLINICAL EVIDENCE IV (retrospective review).
Collapse
Affiliation(s)
- Sharon Clee
- Department of Podiatric Surgery, Northamptonshire Healthcare NHS Foundation Trust (NHFT), Northampton, UK
- Department of Podiatric Surgery Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Private Practice, The Park Hospital, Nottingham; and Circle Nottingham, Nottingham, UK
| | - George Flanagan
- Department of Podiatric Surgery, Northamptonshire Healthcare NHS Foundation Trust (NHFT), Northampton, UK
- Private Practice, Three Shires Hospital Northampton, Northamptonshire, UK
| | - Julian Pavier
- Department of Podiatric Surgery Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Private Practice, The Park Hospital, Nottingham; and Circle Nottingham, Nottingham, UK
| | - Ian Reilly
- Department of Podiatric Surgery, Northamptonshire Healthcare NHS Foundation Trust (NHFT), Northampton, UK
- Private Practice, Three Shires Hospital Northampton, Northamptonshire, UK
- Private Practice, Ramsay Woodlands Hospital, Kettering, Northamptonshire UK
| |
Collapse
|
15
|
Meyr AJ, Doyle MD, King CM, Kwaadu KY, Nasser EM, Ramdass R, Theodoulou MH, Zarick CS. The American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Hallux Valgus. J Foot Ankle Surg 2022; 61:369-383. [PMID: 34706857 DOI: 10.1053/j.jfas.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship - Palo Alto Medical Foundation, Mountain View, CA
| | - Christy M King
- Residency Director, Kaiser San Francisco Bay Area Foot & Ankle Residency Program and Attending Surgeon, Kaiser Foundation Hospital, Oakland, CA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | | | - Roland Ramdass
- Residency Training Committee, INOVA Fairfax Medical Campus, Fairfax, VA
| | - Michael H Theodoulou
- Chief Division of Podiatric Surgery, Cambridge Health Alliance, and Instructor of Surgery, Harvard Medical School, Boston, MA
| | - Caitlin S Zarick
- Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| |
Collapse
|
16
|
Conti MS, Patel TJ, Zhu J, Elliott AJ, Conti SF, Ellis SJ. Association of First Metatarsal Pronation Correction With Patient-Reported Outcomes and Recurrence Rates in Hallux Valgus. Foot Ankle Int 2022; 43:309-320. [PMID: 34612760 DOI: 10.1177/10711007211046938] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine if a postoperative decrease in first metatarsal pronation on 3-dimensional imaging was associated with changes in patient-reported outcomes as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function, pain interference, and pain intensity domains or recurrence rates in patients with hallux valgus (HV) who undergo a first tarsometatarsal fusion (modified Lapidus procedure). METHODS Thirty-nine consecutive HV patients who met the inclusion criteria and underwent a modified Lapidus procedure had preoperative and ≥2-year postoperative PROMIS scores and had first metatarsal pronation measured on preoperative and at least 5-month postoperative weightbearing CT scans were included. Multivariable regression analyses were used to investigate differences in the change in PROMIS domains preoperatively and 2 years postoperatively between patients with "no change/increased first metatarsal pronation" and "decreased first metatarsal pronation." A log-binomial regression analysis was performed to identify if a decrease in first metatarsal pronation was associated with recurrence of the HV deformity. RESULTS The decreased first metatarsal pronation group had a significantly greater improvement in the PROMIS physical function scale by 7.2 points (P = .007) compared with the no change/increased first metatarsal pronation group. Recurrence rates were significantly lower in the decreased first metatarsal pronation group when compared to the no change/increased first metatarsal pronation group (risk ratio 0.25, P = .025). CONCLUSION Detailed review of this limited cohort of patients who underwent a modified Lapidus procedure suggests that the rotational component of the HV deformity may play an important role in outcomes and recurrence rates following the modified Lapidus procedure. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
| | | | - Jiaqi Zhu
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | |
Collapse
|
17
|
Tan CC, Sayampanathan AA, Kwan YH, Yeo W, Singh Rikhraj I, Yeo NEM. Validity and Reliability of the American Orthopaedic Foot and Ankle Society Score for the English-Literate Singapore Population With Hallux Valgus. Foot Ankle Spec 2022:19386400221079490. [PMID: 35189715 DOI: 10.1177/19386400221079490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study aimed to evaluate the reliability and validity of the American Orthopaedic Foot and Ankle Society Metatarsophalangeal-Interphalangeal (AOFAS MTP-IP) score in patients with hallux valgus in Singapore. METHOD A total of 121 English-literate patients with hallux valgus identified between October 2017 and May 2020 were analyzed. Reliability was assessed via Cronbach α. Construct validity was evaluated through 20 a priori hypotheses by correlating the AOFAS MTP-IP score for hallux and lesser toes with other patient-reported outcome measures (PROMs). Standardized response means (SRMs) were calculated to evaluate responsiveness at 6 months postoperative. Structural validity was evaluated via confirmatory factor analysis (CFA) whereby a good fit was indicated when comparative fit index (CFI) is >0.95, Tucker-Lewis index (TLI) is >0.95 and standardized root mean residual (SRMR) is <0.08. RESULTS The AOFAS MTP-IP score demonstrated reliability with a Cronbach α of 0.837. Convergent construct validity was confirmed when all a priori hypotheses were fulfilled. Structural validity was established with our AOFAS MTP-IP score model that displayed good fit for a 1-factor structure (CFI = 0.988, TLI = 0.960, SRMR = 0.034). Responsiveness of the AOFAS MTP-IP score for hallux was demonstrated by an SRM score of 1.28. CONCLUSION The AOFAS MTP-IP score displayed adequate reliability and validity among English-literate patients in Singapore with an operatively managed hallux valgus. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
Collapse
Affiliation(s)
- Chin Chuen Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | | |
Collapse
|
18
|
Siddiqui NA, Mayer BE, Fink JN. Short-Term, Retrospective Radiographic Evaluation Comparing Pre- and Postoperative Measurements in the Chevron and Minimally Invasive Distal Metatarsal Osteotomy for Hallux Valgus Correction. J Foot Ankle Surg 2021; 60:1144-1148. [PMID: 34090745 DOI: 10.1053/j.jfas.2021.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/22/2021] [Indexed: 02/03/2023]
Abstract
Various techniques exist for correction of mild to moderate hallux valgus (HAV) deformity. Recently, minimally invasive distal metatarsal osteotomy (MIDMO) has gained popularity for HAV correction. This retrospective radiographic review aims to report the surgical correction obtained by the chevron and MIDMO osteotomies at a single institution between January 2012 and December 2017. Radiographic parameters, such as intermetatarsal angle (IMA), hallux abductus angle (HAA), and tibial sesamoid position (TSP), were compared on weight-bearing anterior-posterior and lateral radiographs. Sixty-one patients who underwent distal first metatarsal osteotomies were separated into 2 groups. Group A included 30 patients with a chevron bunionectomy performed by Surgeon A; Group B consisted of 31 patients who had MIDMO performed by Surgeon B. Mean follow-up was 26.6 months for Group A and 18.7 months for Group B. Both groups had statistically significant radiographic correction for pre- and postoperative IMA, HAA, and TSP. Group A: IMA measured preoperatively 11.6° ± 4.0° to 6.8° ± 4.1° postoperatively, HAA preoperative 22.2° ± 9.1° to 12.3° ± 6.9° postoperative, and TSP preoperative 1.3 ± 0.9 to 0.7 ± 0.6 postoperative. Group B: IMA measured preoperatively 12.0° ± 2.9° to 5.9° ± 3.3° postoperatively, HAA preoperative 27.9° ± 8.6° to 12.0° ± 6.6° postoperative, and TSP preoperative 2.0 ± 0.8 to 0.7 ± 0.6 postoperative. Postsurgical retrospective radiographic review demonstrated chevron and MIDMO procedures provide comparable radiographic correction of IMA, HAA, and TSP.
Collapse
Affiliation(s)
- Noman A Siddiqui
- Director, Podiatric Surgery, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; Director, Foot and Ankle Deformity Correction and Orthoplastics Fellowship, Chief of Podiatry, Northwest Hospital, Randallstown, MD.
| | - Brittany E Mayer
- Fellow, Foot and Ankle Deformity Correction and Orthoplastics, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | | |
Collapse
|
19
|
Reilly ME, Conti MS, Day J, MacMahon A, Chrea B, Caolo KC, Williams N, Drakos MC, Ellis SJ. Modified Lapidus vs Scarf Osteotomy Outcomes for Treatment of Hallux Valgus Deformity. Foot Ankle Int 2021; 42:1454-1462. [PMID: 34085579 DOI: 10.1177/10711007211013776] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Lapidus procedure and scarf osteotomy are indicated for the operative treatment of hallux valgus; however, no prior studies have compared outcomes between the procedures. The aim of this study was to compare clinical and radiographic outcomes between patients with symptomatic hallux valgus treated with the modified Lapidus procedure versus scarf osteotomy. METHODS This retrospective cohort study included patients treated by 1 of 7 fellowship-trained foot and ankle surgeons. Inclusion criteria were age older than 18 years, primary modified Lapidus procedure or scarf osteotomy for hallux valgus, minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and minimum 3-month postoperative radiographs. Revision cases were excluded. Clinical outcomes were assessed using 6 PROMIS domains. Pre- and postoperative radiographic parameters were measured on anteroposterior (AP) and lateral weightbearing radiographs. Statistical analysis utilized targeted minimum-loss estimation (TMLE) to control for confounders. RESULTS A total of 136 patients (73 Lapidus, 63 scarf) with an average of 17.8 months of follow-up were included in this study. There was significant improvement in PROMIS physical function scores in the modified Lapidus (mean change, 5.25; P < .01) and scarf osteotomy (mean change, 5.50; P < .01) cohorts, with no significant differences between the 2 groups (P = .85). After controlling for bunion severity, the probability of having a normal postoperative intermetatarsal angle (IMA; <9 degrees) was 25% lower (P = .04) with the scarf osteotomy compared with the Lapidus procedure. CONCLUSION Although the modified Lapidus procedure led to a higher probability of achieving a normal IMA, both procedures yielded similar improvements in 1-year patient-reported outcome measures. LEVEL OF EVIDENCE Level III, retrospective cohort.
Collapse
Affiliation(s)
| | | | | | | | - Bopha Chrea
- School of Medicine, Orthopedic Surgery, Oregon Health & Science University, Portland, OR, USA
| | | | - Nicholas Williams
- Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA
| | | | | |
Collapse
|
20
|
Crooks SA, Lewis TL, Ray R, Gordon DJ. Symmetry of bilateral hallux valgus deformity: A radiographic study. Clin Anat 2021; 35:414-420. [PMID: 34390035 DOI: 10.1002/ca.23772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/21/2021] [Accepted: 08/01/2021] [Indexed: 11/09/2022]
Abstract
Hallux valgus (HV) is a common anatomical deformity leading to pain and difficulty with footwear and mobility. Bilateral HV deformity is much more common than unilateral although it remains unclear whether the severity of deformity is equal between feet. The objective was to investigate the severity and symmetry of HV in patients with bilateral symptomatic deformity presenting for surgery. Weight-bearing radiographs of patients presenting with symptomatic bilateral HV were reviewed. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured and classified as mild, moderate, or severe. Left-to-right comparison was undertaken to assess whether the degree of deformity was similar for each foot. The relationship between age, HVA, and IMA was also assessed. Between July 2014 and June 2020, 322 ft (161 patients with bilateral deformity) underwent corrective HV surgery. Of those, 6.8%, 64.6%, and 28.4% were classified as mild, moderate, and severe, respectively on the left side, and on the right 6.2%, 67.7%, and 26.1% were classified as mild, moderate, and severe respectively. There was no statistically significant difference between feet for either IMA (p = 0.06) or HVA (p = 0.85). There was a moderate correlation (R = 0.41, p ≤ 0.001) between HVA and IMA. There was only a 'weak' or 'very weak' correlation between age and HVA or IMA. Patients presenting for surgery with symptomatic bilateral HV have symmetrical moderate radiographic deformity at the time they present for consideration of surgical intervention.
Collapse
Affiliation(s)
- Sophie A Crooks
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Thomas L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | | |
Collapse
|
21
|
Steadman J, Bakshi N, Arena C, Leake R, Barg A, Saltzman CL. Normative Distribution of First Metatarsal Axial Rotation. Foot Ankle Int 2021; 42:1040-1048. [PMID: 33890512 DOI: 10.1177/10711007211001015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND First metatarsal (M1) axial rotation is recognized as a clinically relevant component of hallux valgus deformity. Methods to realign the M1 in 3 dimensions have been developed. One goal of these operations is to restore normal rotation of the first ray. The aim of this study is to provide estimates for the normal distribution of M1 rotation in patients without relevant anatomic pathology. METHODS Using stringent clinical and radiographic criteria, we evaluated a set of plain radiograph and weightbearing computed tomography (WBCT) images of 62 feet from a consecutive patient database. Subjects included had normal foot alignment without bunion symptoms. M1 rotation of each foot was measured using 2 unique methods (Saltzman et al and Kim et al methods). Measurement of rotation was performed by 2 observers from coronal WBCT images. Mean values and confidence intervals (CIs) of M1 rotation were calculated for each method. Inter- and intraobserver reliability values were also reported. RESULTS Mean M1 rotation values of 2.1 degrees (95% CI: 0.9-3.4) and 6.1 degrees (95% CI: 4.4-7.8) were identified using the Saltzman et al and Kim et al methods, respectively. Inter- and intraobserver reliability values were interpreted as excellent for both methods. CONCLUSION In this study, we describe the natural distribution of the M1 axial rotation in subjects without bunion or other identifiable bony foot deformities. This information should provide a normative reference for surgeons correcting rotational issues of the first metatarsal. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Jesse Steadman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Neil Bakshi
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Christopher Arena
- Orthopedic Sports Institute, Institute for Orthopedic Research & Innovation, Coeur d'Alene, ID, USA
| | - Richard Leake
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany
| | | |
Collapse
|
22
|
Choi SM, Lee JS, Lim JW, Im JM, Kho DH, Jung HG. Effect of Metatarsus Adductus on Hallux Valgus Treated With Proximal Reverse Chevron Metatarsal Osteotomy. Foot Ankle Int 2021; 42:886-893. [PMID: 33588635 DOI: 10.1177/1071100721990363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to compare clinical and radiographic outcomes and recurrence rates after reverse proximal chevron metatarsal osteotomy (PCMO) for patients with hallux valgus (HV) with or without metatarsus adductus (MA). We hypothesized that patients with MA would have poorer outcomes and a higher radiographic recurrence rate than those without MA. METHODS This retrospective single-surgeon series comprised 144 patients (173 feet) with moderate to severe HV, treated with PCMO and Akin osteotomy without lesser metatarsal procedures, who were grouped according to the presence (MA group) or absence of MA (non-MA group). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Radiographic assessments included metatarsus adductus angle (MAA), HV angle (HVA), and intermetatarsal angle (IMA). RESULTS The prevalence of the MA was 24.2%. The mean MAA was 23.1 ± 3.3 degrees in the MA group. There were no differences in the mean AOFAS score and pain VAS score at the final follow-up between the 2 groups (all P > .05). The patient satisfaction rate was 73.8% in the MA group vs 90.1% in the non-MA group (P = .017). The mean postoperative HVA and IMA significantly improved at the final follow-up in both groups, respectively (all P < .001). Preoperative and postoperative HVA were larger in the MA group vs non-MA group. However, no significant difference was found in the improvement of HVA and IMA after surgery between the 2 groups (all P > .05). The recurrence rate was 28.6% in the MA group and 6.1% in the non-MA group (P < .001). CONCLUSION HV patients associated with the MA had a higher degree of preoperative HV, lower correction of the HVA, higher radiographic recurrence rate, and poorer patient satisfaction than those without MA post-PCMO without lesser metatarsal procedures. Therefore, a more extensive HV correction procedure or the addition of a lesser metatarsal realignment procedure may need to be considered. LEVEL OF EVIDENCE Level III, retrospective comparative series.
Collapse
Affiliation(s)
- Seung-Myung Choi
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Eulji University School of Medicine, Eulji University Uijeongbu Hospital, Republic of Korea
| | - Jong-Soo Lee
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jung-Won Lim
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Je-Min Im
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Duk-Hwan Kho
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Konkuk University Chungju Hospital, Republic of Korea
| | - Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
23
|
Goh GS, Tay AYW, Thever Y, Koo K. Effect of Age on Clinical and Radiological Outcomes of Hallux Valgus Surgery. Foot Ankle Int 2021; 42:798-804. [PMID: 33451267 DOI: 10.1177/1071100720982975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prevalence of hallux valgus increases with age. However, no studies have compared the effectiveness of surgical correction among different age groups. This study investigated the influence of age on clinical and radiological outcomes following hallux valgus surgery. METHODS Patients who underwent correction for hallux valgus at an academic hospital were stratified into 3 age groups: younger (<50 years), middle-aged (50-59 years), and older (≥60 years). Functional outcomes and satisfaction questionnaires were collected preoperatively and at 6 months and 2 years postoperatively. Radiological recurrence and reoperations were recorded at follow-up. There were 193 patients (93% female): 34 younger, 74 middle-aged, and 85 older. RESULTS The preoperative hallux valgus angle was significantly greater in older patients (P < .001). The older group had 3 perioperative complications (P = .144) and showed a trend toward a longer hospital stay (P = .083). There was no difference in visual analog scale, American Orthopaedic Foot & Ankle Society score, or SF-36 among the groups at 6 months or 2 years. Using multiple regression, age was not associated with any outcome score. The satisfaction rates were 82%, 78%, and 83% in the young, middle-aged, and older groups, respectively (P = .698). There was no difference in the number of reoperations at a mean follow-up of 9.2 ± 2.2 years (P = .778), and no patients underwent reoperation for recurrent hallux valgus. The risk of recurrence was 5 times higher in older patients compared with younger patients (OR, 5.15; 95% CI, 1.10-24.03; P = .037). CONCLUSION Age did not influence the perioperative, functional, or subjective outcomes following hallux valgus surgery. However, older patients should be counseled on the higher risk of recurrence following surgical correction. LEVEL OF EVIDENCE Therapeutic, level III, retrospective comparative series.
Collapse
Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Adriel You Wei Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Yogen Thever
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
24
|
McKeown R, Rabiu AR, Ellard DR, Kearney RS. Primary outcome measures used in interventional trials for ankle fractures: a systematic review. BMC Musculoskelet Disord 2019; 20:388. [PMID: 31455297 PMCID: PMC6712770 DOI: 10.1186/s12891-019-2770-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 08/19/2019] [Indexed: 12/19/2022] Open
Abstract
Background Ankle fractures cause considerable pain, loss of function and healthcare resource use. High quality randomised controlled trials are required to evaluate the optimal management protocols for ankle fracture. However, there is debate regarding the most appropriate outcome measure to use when assessing patients with ankle fractures. The aim of this systematic review is to identify and summarise primary outcome measure use in clinical trials of non-pharmacological interventions for adults with an ankle fracture. Methods We performed comprehensive searches of the Medline, Embase, CINAHL, AMED and Cochrane CENTRAL databases, as well as ISRCTN and ClinicalTrials.gov online clinical trial registries on 19/06/2019 with no date limits applied. The titles and abstracts were initially screened to identify randomised or quasi-randomised clinical trials of non-pharmacological interventions for ankle fracture in adults. Two authors independently screened the full text of any articles which could potentially be eligible. Descriptive statistics we used to summarise the outcome measures collected in these articles including an assessment of trends over time. Secondary analysis included a descriptive summary of the multi-item patient reported outcome measures used in this study type. Results The searches returned a total of 3380 records. Following application of the eligibility criteria, 121 records were eligible for inclusion in this review. The most frequently collected primary outcome measures in this type of publication was the Olerud Molander Ankle Score, followed by radiographic and range of movement assessments. There was a total of 28 different outcome measures collected and five different multi-item, patient reported outcome measures collected as the primary outcome measure. There was a sequential increase in the number of this type of study published per decade since the 1980’s. Conclusion This review demonstrates the wide range of measurement methods used to assess outcome in adults with an ankle fracture. Future research should focus on establishing the validity and reliability of the outcome measures used in this patient population. Formulation of a consensus based core outcome set for adults with an ankle fracture would be advantageous for ensuring homogeneity across studies in order to meta-analyse trial results. Electronic supplementary material The online version of this article (10.1186/s12891-019-2770-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rebecca McKeown
- Warwick Medical School, Warwick Clinical Trials Unit, University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Abdul-Rasheed Rabiu
- Trauma and Orthopaedics Department, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - David R Ellard
- Warwick Medical School, Warwick Clinical Trials Unit, University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Rebecca S Kearney
- Warwick Medical School, Warwick Clinical Trials Unit, University of Warwick, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| |
Collapse
|
25
|
Desai S, Peterson AC, Wing K, Younger A, Crump T, Liu G, Veljkovic A, Penner M, Sutherland JM. Minimally Important Difference in the Foot and Ankle Outcome Score Among Patients Undergoing Hallux Valgus Surgery. Foot Ankle Int 2019; 40:694-701. [PMID: 30873859 DOI: 10.1177/1071100719831392] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-reported outcomes are increasingly used as measures of effectiveness of interventions. To make the tools more useful, therapeutic thresholds known as minimally important differences have been developed. The objective of this study was to calculate minimally important differences for the domains of the Foot and Ankle Outcome Score for hallux valgus surgery. METHODS The study was based on a retrospective analysis of patients newly scheduled for bunion correction surgery and completing patient-reported outcomes between October 2013 and January 2018. This study used anchor- and distribution-based approaches to calculate the minimally important difference for the instrument's 5 domains. Confidence intervals were calculated for each approach. There were 91 participants included in the study. RESULTS Using anchor- and distribution-based approaches, the minimally important difference for the pain domain ranged from 5.8 to 10.2, from 0.3 to 6.9 for the symptoms domain, 8.3 to 10.3 for the activities of daily living domain, 7.4 to 11.1 for the quality of life domain, and from 7.0 to 15.7 for the sports and recreation domain. Small differences in the activities of daily living domain may be more clinically important for patients with better function. DISCUSSION The range of minimally important difference values for each domain indicate how the Foot and Ankle Outcome Score corresponded to bunion correction surgery. The sports and recreation domain showed considerable variability in the range of values and may be associated with the domain's lack of responsiveness. Overall, most minimally important difference values for the domains of FAOS ranged from above 4 to below 16. LEVEL OF EVIDENCE Level III, retrospective comparative series.
Collapse
Affiliation(s)
- Sameer Desai
- 1 School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Alexander C Peterson
- 2 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kevin Wing
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Alastair Younger
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Trafford Crump
- 4 Department of Surgery, University of Calgary, Calgary, Alberta
| | - Guiping Liu
- 2 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Andrea Veljkovic
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Murray Penner
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Jason M Sutherland
- 2 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| |
Collapse
|