Effect of Severity of Deformity on Clinical Outcomes of Scarf Osteotomies

Preoperative Degenerative Changes at the Tibial Sesamoid-Metatarsal Joint in Hallux Valgus: Association With Postoperative Patient-Reported Outcomes After Modified Lapidus Procedure

Background

Degenerative changes at the sesamoid-metatarsal joints (SMJs) may be a source of pain following hallux valgus surgery. The aims of this study were to describe degenerative changes at the SMJs on weightbearing computed tomography (WBCT) scans and, secondarily, investigate their association with 1-year patient-reported outcome scores following a modified Lapidus procedure for hallux valgus. We hypothesized that reduced joint space in the SMJs would correlate with worse patient-reported outcomes.

Methods

Fifty-seven hallux valgus patients who underwent a modified Lapidus procedure had preoperative and minimum 5-month postoperative WBCT scans, and preoperative and at least 1-year postoperative PROMIS physical function (PF), pain interference, and pain intensity scores were included. Degenerative changes at the SMJs were measured using distance mapping between the sesamoids and first metatarsal head on preoperative and postoperative WBCT scans. The minimum and average distances between the first metatarsal head and tibial sesamoid (tibial-SMJ) for each patient preoperatively and postoperatively were measured. Sesamoid station was measured on WBCT scans using a 0 to 3 grading system. Linear regression was used to investigate the correlations between minimum preoperative and postoperative tibial-SMJ distances and 1-year postoperative PROMIS scores.

Results

The median minimum and average tibial-SMJ distances increased from 0.82 mm (interquartile range [IQR] 0.40-1.03 mm) and 1.62 mm (IQR 1.37-1.75 mm) preoperative to 1.09 mm (IQR 0.96-1.23 mm) and 1.73 mm (IQR 1.60-1.91 mm) postoperative (P < .001 and P < .001), respectively. In a subset of patients with complete sesamoid reduction, we found an association between preoperative minimum tibial-SMJ distance and 1-year postoperative PROMIS PF scores (coefficient 7.2, P = .02).

Conclusion

Following the modified Lapidus procedure, there was a statistically significant increase in the tibial-SMJ distance. Additionally, in patients with reduced sesamoids postoperatively, reduced preoperative tibial-SMJ distance correlated with worse PROMIS PF scores.

Level of Evidence

Level IV, case series.

Proximal Supination Osteotomy for Hallux Valgus: Comparison of Clinical and Radiologic Outcomes for the Most Severe Deformities

BACKGROUND

There is little available information regarding the difference in outcomes between severe hallux valgus (S-HV), defined as 40 degrees ≤ hallux valgus angle (HVA) < 50 degrees, and what we consider to be "super-severe HV" (SS-HV), defined as >50 degrees, following a proximal metatarsal osteotomy. We aimed to retrospectively compare the outcomes of a proximal metatarsal osteotomy in S- and SS-HV.

METHODS

The series consisted of 57 female patients (57 feet) treated with a proximal supination osteotomy for symptomatic S- and SS-HV (33 and 24 feet, respectively). The outcome measures included radiographic parameters and for 45 patients included the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score, and a visual analog scale pain score (VAS-PS) preoperatively and at a minimum follow-up of 12 months with a median of 26 months. No significant differences were found in age, body mass index, and the duration of follow-up between patients with S-HV and SS-HV (P > .10 for all comparisons) with the numbers available.

RESULTS

Preoperative HVA in patients with S- and SS-HV was significantly improved at the final follow-up (P < .0001 for both comparisons). No significant differences in postoperative HVA and IMA were observed between patients with S- and SS-HV (P = .51 and .50, respectively). All 5 preoperative subscale scores of SAFE-Q in patients with S- and SS-HV significantly improved postoperatively (P < .01 for all comparisons). Preoperative VAS-PS in patients with S- and SS-HV significantly improved postoperatively (P < .0001 and <.009, respectively). There were no significant differences in preoperative and postoperative scores of all the SAFE-Q subscales and VAS-PS between patients with S-HV and SS-HV (P > .10 for all) with the numbers available.

CONCLUSION

We found for this patient group that a proximal supination osteotomy can achieve a large correction for SS-HV as well as S-HV and significantly improve radiologic and clinical outcomes in SS-HV. The outcomes between patients with S- and SS-HV were not different in this series.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Minimally invasive Chevron Akin (MICA) osteotomy for severe hallux valgus

INTRODUCTION

The minimally invasive Chevron Akin (MICA) osteotomy has been widely used to treat hallux valgus (HV). The purpose of this study was to present a case series of patients with severe HV undergoing surgical treatment using the MICA procedure and to evaluate the clinical and radiographic outcomes.

MATERIALS AND METHODS

Retrospective study including 60 consecutive feet (52 patients) undergoing MICA for severe HV. The data were collected pre- and post-operatively at the last follow-up. Patients were clinically evaluated by the visual analog pain scale (VAS) and AOFAS hallux MTP-IP score. Radiographic assessments included measurements of hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsal (MT) length, distal metatarsal articular angle (DMAA), and plantar translation of MT head. The complications were recorded during the follow-up.

RESULTS

The mean age was 59.9 years, and the mean follow-up was 20.5 months. The average AOFAS increased from 41.2 to 90.9 points, and the VAS from 8.1 to 1.3 at the last follow-up. The average HVA decreased from 41.2º to 11.6º, the IMA from 17.1º to 6.9º, and the DMAA from 17.9º to 7.8º. The average shortening of the first metatarsal and the plantar translation of the MT head was 5.1 mm and 2.8 mm, respectively. The most observed complication was hardware discomfort, observed in 5 feet (8.3%). There were two cases of recurrence (3.3%).

CONCLUSION

MICA technique was demonstrated in this series of cases to be an effective procedure for severe HV, with a low rate of recurrence and an acceptable rate of complications.

LEVEL OF EVIDENCE

IV; case series.

Hallux valgus with second metatarsalgia: Is second metatarsal Weil osteotomy necessary?

BACKGROUND

The role of concomitant Weil osteotomy to address second toe metatarsalgia during hallux valgus correction is unclear. We aimed to critically analyse outcomes of an additional Weil osteotomy versus isolated Scarf osteotomy.in the management of hallux valgus and second metatarsalgia.

METHODS

Patients with second toe metatarsalgia who underwent first metatarsal Scarf osteotomy for hallux valgus were enrolled retrospectively. Demographics, radiographic measurements and functional outcomes were assessed at baseline, 6-months and 2-years postoperatively. Between-group significance was established with Fisher exact test, Chi-square or Mann-Whitney U test. Within-group changes from baseline were assessed with paired t-test and Wilcoxon signed-rank test.

RESULTS

48 feet (34 isolated Scarf, 14 concomitant Weil osteotomy) were included. Both cohorts demonstrated significant improvements across all measures of functional outcome. However, patients with additional Weil osteotomy reported poorer short-term outcomes.

CONCLUSION

Superiority of additional Weil osteotomy versus isolated Scarf osteotomy in addressing second toe metatarsalgia or improving functional outcomes was not demonstrated.

A Better Treatment for Moderate to Severe Hallux Valgus: Scarf + Akin Osteotomy Combined with Lateral Soft Tissue Release in a Single Medial Incision

Objective

Traditional lateral soft tissue release (LSTR) was conducted by an additional dorsal first web incision, as the malformed thick scar and neuritis were common after surgery. A new method of lateral soft tissue release in a single medial incision via dorsal flap over the first metatarsal (LSTR‐SMI‐DFFM) should be recommended. The objective is to investigate the clinical effectiveness and safety of scarf + Akin osteotomy (SAO) combined with lateral soft tissue release in a single medial incision via dorsal flap over the first metatarsal (LSTR‐SMI‐DFFM) for moderate to severe hallux valgus.

Methods

Patients who were performed surgery for hallux valgus from April 2014 to June 2020 were retrospectively reviewed. The visual analog scale (VAS) was recorded before surgery and during follow‐up, as well as the forefoot score of the American Orthopaedic Foot and Ankle Society (AOFAS). Patient satisfaction was evaluated at the follow‐up time. The preoperative and follow‐up weightbearing X‐ray were conducted in all patients. The radiological parameters of hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured. Tibial sesamoid position (TSP) was also recorded according to seven‐part grading system. The quantitative data were performed as mean ± standard deviation or median ± interquartile range. Student's t test was performed in HVA, IMA, and DMAA. The TSP, VAS, and AOFAS were statistical analyzed by Mann–Whitney U test. p value of <0.05 was considered significant.

Results

There were 123 feet conducted surgery in 96 patients. The AOFAS score improved a lot which was preoperative 39 to 100 at the follow‐up time and VAS was 4 to 0 (p < 0.001). A total of 63 (51.2%) patients were very satisfied, 47 (38.2%) were satisfied, five (4.1%) were undecided and eight (6.5%) were not satisfied. The HVA, IMA, DMAA, and TSP were all decreased after surgery and were statistically significant (p < 0.001).

Conclusion

The SAO combined with a LSTR‐SMI‐DFFM for moderate to severe hallux valgus is effective and safe with pretty good clinical and radiographic results, as well as minimal complications. The corrections of AOFAS and VAS conformed to the minimum clinically important difference (MCID).

Contribution Ratio of Metatarsal Osteotomy and First Tarsometatarsal Joint Reduction in Moderate to Severe Hallux Valgus Correction

Hallux valgus is a common foot and ankle disease, for which numerous surgical procedures were introduced. So, understanding the mechanism of deformity reduction is important to select the proper method. Intermetatarsal angle (IMA) determines the severity of hallux valgus, which is influenced by the translated metatarsal head and the reduction of the first tarsometatarsal joint. We hypothesized that both of the mechanisms simultaneously contribute to the correction of IMA. Hallux valgus (70 feet) operated with a Scarf osteotomy with the Akin procedure were reviewed. Hallux valgus angle (HVA), IMA (mechanical and anatomical), hallux valgus interphalangeal angle (HVIP), distal metatarsal articular angle (DMAA), and sesamoid position were checked. The ratio of contributions to the IMA changes were calculated and compared. When the individual contributions by metatarsal head translation and first tarsometatarsal joint reduction were compared, metatarsal head translation contributed by 82%, whereas first tarsometatarsal joint reduction contributed by 18%. Both were responsible for mechanical IMA correction. However, IMA change by metatarsal head translation was a major correction mechanism compared to anatomical IMA change by first tarsometatarsal joint reduction.

Minimally invasive surgery for severe hallux valgus in 106 feet

BACKGROUND

There is widespread variation in the optimal procedure for correction of severe hallux valgus deformity defined as hallux valgus angle (HVA) (≥40°) and/or 1-2 intermetatarsal angle (IMA) (≥20°). There is limited evidence investigating the clinical or radiological outcomes following treatment of severe hallux valgus deformity with third-generation minimally invasive chevron and Akin osteotomies (MICA).

METHODS

This was a prospective observational single surgeon series of consecutive patients who underwent primary third-generation MICA with screw fixation for severe hallux valgus. The primary outcome was a validated patient reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ), assessed minimum 2 years following MICA. Secondary outcomes were radiographic deformity correction (assessed 6 weeks post-operatively), complication rates and other quality of life PROMs (EQ-5D and Visual Analogue Pain Scale).

RESULTS

Between September 2014 and November 2018, 106 consecutive feet (n = 78 patients; 73 female, 5 male) met the inclusion criteria. Prospectively collected pre-operative and 2 year PROM MOXFQ data was available for 86 feet (81.1%). At two years following surgery, the MOXFQ score significantly improved for the Pain, Walking and Standing and Social Interaction domains from 39.2 to 7.5, 38.2 to 5.9 and 48.6 to 5.5, respectively (p < 0.001). Pre- and 6 week post-operative radiographic data was available for all 106 feet. Mean IMA improved from 18.2° to 6.3° (p < 0.001) whilst mean HVA improved from 45.3° to 10.9° (p < 0.001). The complication rate was 18.8% and the screw removal rate was 5.6%.

CONCLUSION

This study has demonstrated third-generation MICA for the treatment of severe hallux valgus deformity enables substantial deformity correction and is associated with significant improvements in clinical PROMs 2 years following surgery.

Preoperative photography improves patient satisfaction following hallux valgus surgery

BACKGROUND

Patient satisfaction is variable following hallux valgus (HV) surgery. This prospective, blinded, randomized trial endeavored to determine whether showing patients a preoperative photograph would improve satisfaction following HV corrective surgery.

METHODS

Adult patients undergoing HV surgery were randomized to a picture group (P) or a no picture group (NP). P-group patients were shown their preoperative photograph for 5 min at each postoperative visit. Outcome measures included the Foot Function Index (FFI), the Foot Ankle Outcome Score (FAOS), and a patient satisfaction questionnaire.

RESULTS

Twenty-nine patients were enrolled in the study (15P, 14 NP). At 3, and 6 months postoperatively, patients in the P-group were more likely to be completely satisfied with the appearance of their foot. There were no differences between groups with respect to postoperative HVA, IMA, or FFI, and FAOS scores.

CONCLUSION

Patient satisfaction is increased following hallux valgus corrective surgery by reminding patients of the preoperative appearance of their foot through the use of photographs.

LEVEL OF EVIDENCE

Level I, randomized control trial.

Clinical Outcomes of Scarf-Akin Osteotomy for Hallux Valgus With Simultaneous Bunionette Correction: A Propensity Score-Matched Cohort Analysis

Hallux valgus and bunionette (Tailor's bunion) deformities are debilitating forefoot deformities that may occur together. Successful outcomes of surgery for either pathology have been well-described; however, the literature is sparce on outcomes of patients undergoing simultaneous surgery for both deformities. Between 2007 and 2018, 429 patients underwent a scarf-Akin osteotomy, and 20 patients underwent simultaneous bunionette surgery. Propensity score matching was used to match the scarf + bunionette group in a 1:2 ratio to a corresponding scarf only group using logistic regression. Their hallux and fifth metatarsal visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale, Short Form-36 (SF-36), expectations and satisfaction scores were recorded at preoperative, 6-month and 2-year intervals. There were no differences in baseline characteristics between groups after matching (p > .05). At 6 months, the scarf + bunionette group had a significantly worse fifth metatarsal AOFAS (80.7 vs 92.9, p = .002) and VAS (1.5 vs 0.1, p = .008). However, at 2 years, greater improvements in the scarf + bunionette group resulted in no significant differences for fifth metatarsal AOFAS and VAS. The scarf + bunionette group had better SF-36 scores in the domains of physical functioning, bodily pain, general health and mental health (p < .05). Scarf + bunionette patients trended toward higher satisfaction (100.0% vs 85.0%, p = .165) and expectation fulfilment (95.0% vs 80.0%, p = .249) at 2 years, although not significant with the available numbers. In patients with similar baseline hallux and fifth metatarsal pain and function, simultaneous surgery and a scarf osteotomy alone result in similar improvements to pain and function at 2 years. However, patients who undergo both procedures have higher quality of life scores.

The Association of Crista Volume With Sesamoid Position as Measured From 3D Reconstructions of Weightbearing CT Scans

BACKGROUND

Malposition of the sesamoids relative to the first metatarsal head may relate to intersesamoid crista underdevelopment or erosion. Using 3-dimensional models created from weightbearing CT (WBCT) scans, the current work examined crista volume and its relationship to first metatarsal pronation and sesamoid station.

METHODS

Thirty-eight hallux valgus (HV) patients and 10 normal subjects underwent weightbearing or simulated WBCT imaging. The crista was outlined by the inferior articular surface, and a line was drawn to connect the lowest point of each sulcus on either side of the intersesamoidal crista throughout the length of the crista. The volume was calculated. Sesamoid station and first metatarsal pronation were calculated from the 3D reconstructions. The mean crista volumes between HV and normal patients were statistically compared, as were the crista volume and pronation angle between sesamoid stations.

RESULTS

The mean crista volume in HV patients was 80.10 ± 35 mm³ and in normal subjects was 150.64 ± 24 mm³, which differed significantly between the 2 groups (P < .001). Mean crista volumes were found to be statistically significantly different between the sesamoid stations (P < .001) with decreasing crista volumes significantly and strongly correlated with increasing sesamoid station (r = -0.80, P < .001). There was no difference in the mean pronation angle between the 4 sesamoid stations (P = .37). The pronation angle was not associated with crista volume (P = .52).

CONCLUSION

HV patients have lower mean crista volume than normal patients. Crista volume is correlated with sesamoid station. Pronation of the first metatarsal was not associated with crista volume.

CLINICAL RELEVANCE

Crista volume may offer an additional determinant for the severity of hallux valgus.

Association of Visual Appearance on Outcomes After Hallux Valgus Surgery

BACKGROUND

In this study, our aim was to determine the effect of cosmetic improvement on patient satisfaction and functional scores in hallux valgus (HV) surgery.

METHODS

Preoperative foot photographs of 105 patients who had undergone chevron osteotomy for HV between 2016 and 2018 were taken. The patients were divided into 2 groups. Twenty-four months after surgery, the preoperative foot photographs were shown to patients in group 1 (n = 52) but not to patients in group 2 (n = 53). The groups were then compared using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP), and the 36-Item Short Form Health Survey (SF-36) scores. Both groups were evaluated radiologically with preoperative and postoperative hallux valgus angles and intermetatarsal angles.

RESULTS

There was no difference between the 2 groups in terms of radiologic parameters either pre- or postoperatively, or AOFAS Hallux MTP-IP scores postoperatively. However, for group 1, the VAS was lower (0.4±0.8 vs 1.8±1.6, P = .003) and both the SF-36 physical functioning (88.3±18.1 vs 79.1±23.2, P = .017) and SF-36 mental health scores were higher (78.8±19 vs 69.2±16.3, P = .022).

CONCLUSION

Visualizing improvement in the cosmetic appearance of the foot appears associated with patients' perception of subjective pain and functional improvement. We recommend that preoperative foot photographs be taken and recorded.

LEVEL OF EVIDENCE

Level III, case-control study.

Modified Lapidus vs Scarf Osteotomy Outcomes for Treatment of Hallux Valgus Deformity

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.

Percutaneous Chevron and Akin (PECA) Osteotomies for Severe Hallux Valgus Deformity With Mean 3-Year Follow-up

BACKGROUND

Patients with severe hallux valgus deformity present technical and operative challenges with high rates of recurrence and residual deformity. The clinical and radiologic outcomes of percutaneous surgery for severe hallux valgus are not known.

METHODS

A retrospective review of consecutive patients with a hallux valgus angle (HVA) >40 degrees or intermetatarsal angle (IMA) >20 degrees who underwent third-generation percutaneous chevron and Akin osteotomy (PECA) for hallux valgus deformity correction.

RESULTS

Between December 2012 and August 2019, 59 feet in 50 patients underwent PECA. Preoperative and follow-up radiographic data were available for 53 feet (89.8%). Postoperative clinical patient-reported outcome measures and satisfaction results were available for 51 feet (86.4%). The mean clinical and radiographic follow-up was 3.1 years and the mean postoperative Manchester-Oxford Foot Questionnaire Index score was 15.1. There was a statistically significant improvement (P < .001) in both IMA and HVA following surgery (IMA 17.5-5.1 degrees; HVA 44.1-11.5 degrees). All patients reported they were satisfied with their outcome, with 76.8% reporting they were highly satisfied. The hallux valgus recurrence rate was 7.5%.

CONCLUSION

Percutaneous surgery for severe hallux valgus deformity can achieve a large deformity correction, patient satisfaction, and quality of life, with reasonable rates of residual deformity and low rates of recurrence.

LEVEL OF EVIDENCE

Level IV, case series.

Effect of Age on Clinical and Radiological Outcomes of Hallux Valgus Surgery

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.

First Metatarsal Rotation in Hallux Valgus Deformity

Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV pathoanatomy. However, because biplanar radiographs have been the standard method for imaging HV, clinicians primarily developed measurement methods and corrective operations confined to 2 dimensions, medial-lateral and inferior-superior. Recently, as our understanding of HV pathoanatomy has further developed, aided in part by advanced imaging technology, M1 rotation about its axis ("axial rotation") and its implications for HV deformity and treatment has reemerged. The goal of this review is to summarize M1 rotation in HV from a historical perspective, to present the current understanding of its potential role in the etiology/pathogenesis of HV, and to summarize relevant imaging and operative considerations with respect to M1 rotation.Level of Evidence: Level III, systematic review.

Results of Hallux Valgus Surgery in Diabetic Patients With Good Glycemic Control

BACKGROUND

Literature is sparse on whether diabetes affects outcomes of hallux valgus surgery. With the rising global prevalence of diabetes and diabetes being an independent predictor of poorer outcomes, particularly in foot and ankle surgery, we aimed to investigate the impact of diabetes on the outcomes of hallux valgus surgery.

METHODS

We conducted a retrospective comparative cohort study of prospectively collected registry data of 951 feet in 721 patients who underwent surgery for symptomatic hallux valgus between 2007 and 2015 at our institution. All patients with diabetes were identified and matched with patients without diabetes for age, sex, and body mass index in a 1:2 ratio to construct the matched cohorts for analysis. Glycemic control in the diabetic cohort was assessed using preoperative HbA1c. The primary outcome measure was complication rates. Secondary outcomes were (1) deformity correction using the hallux valgus and intermetatarsal angles; (2) patient-reported outcomes using visual analog scale (VAS) for pain, Short Form-36 (SF-36) Physical and Mental Health subscales, and American Orthopaedic Foot & Ankle Society (AOFAS) scores; (3) patient satisfaction; and (4) reoperation rates up to 2 years postoperatively. Forty diabetic patients were identified and matched to 80 nondiabetic patients. Although matching was only performed for age, sex, and body mass index, the diabetic and the nondiabetic cohorts were also similar in hallux valgus severity, preoperative scores, and types of procedures performed.

RESULTS

The mean preoperative HbA1c in our diabetic cohort was 7.1%. Both the diabetic and nondiabetic cohorts showed excellent AOFAS and VAS scores with no differences in degree of deformity correction, complication profiles, reoperation rates, outcome scores, and satisfaction at both 6 months and 2 years postoperatively.

CONCLUSION

We believe stringent patient selection was key to reduced complication rates and good outcomes in diabetic patients. Well-selected diabetic patients remain suitable candidates for hallux valgus surgery.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.