Validity and Reliability of the American Orthopaedic Foot and Ankle Society Score for the English-Literate Singapore Population With Hallux Valgus

Reliability and Validity of the Turkish Version of the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale

BACKGROUND

The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) scale is one of the most widely used outcome measures to evaluate hallux pathologies. This study aimed to translate the AOFAS Hallux MTP-IP scale into Turkish and investigate its psychometric properties.

METHODS

The psychometric properties of the Turkish version of the AOFAS Hallux MTP-IP (AOFAS Hallux MTP-IP-T) scale were tested in 66 patients with hallux pathologies (52 women; mean age, 47.64 ± 12.75 years). Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analogue Scale (VAS), and 12-item Short-Form Health Survey(SF-12).

RESULTS

The AOFAS Hallux MTP-IP-T scale had adequate internal consistency (α = 0.71) and test-retest reliability (ICC2,1 = 0.93 for pain, ICC2,1 = 0.97 for function, and ICC2,1 = 0.97 for total score). The AOFAS Hallux MTP-IP-T total score has a moderate to strong correlation with VAS-activity and MOXFQ (ρ = -0.77, P = .001; ρ = -0.69, P = .001, respectively). The weakest correlation was found between the AOFAS Hallux MTP-IP-T and the SF-12 mental component scale (ρ = 0.31, P = .01).

CONCLUSION

AOFAS Hallux MTP-IP-T has sufficient reliability and validity to evaluate Turkish-speaking individuals with a variety of forefoot pathologies including the hallux.

LEVELS OF EVIDENCE

Level II.

Two-Year Clinical and Radiologic Outcomes Following Surgical Treatment of Insertional Achilles Tendinopathy Using a Central Tendon-Splitting Approach

BACKGROUND

If conservative treatment of insertional Achilles tendinopathy (IAT) fails, surgery is often considered. Various surgical approaches have been used including the central Achilles tendon splitting approach. This study aimed to report the 2-year clinical and radiologic outcomes after surgical treatment of IAT with a central tendon-splitting approach.

METHODS

Seventy-five cases of IAT treated surgically via the open central tendon-splitting approach were analyzed. Clinical outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36) physical (PCS) and mental (MCS) component summary scores, all measured at baseline and 6 and 24 months postoperatively. Radiologic parameters measured included the Fowler-Philip angle (FPA) and parallel pitch lines (PPL).

RESULTS

Three patients had clinically significant wound issues but healed completely by 3 weeks. Mean AOFAS score improved from 45.63 preoperatively to 94.71 at 24 months. Mean VAS score improved from 6.73 preoperatively to 0.55, mean SF-36 PCS from 35.98 to 48.74, and mean SF-36 MCS from 53.04 to 55.43 at 24 months. Satisfaction at 2 years was 94.3%. Mean FPA decreased from 62.0 degrees preoperatively to 34.0 degrees postoperatively. PPL was positive in 82.7% (62 of 75) of cases preoperatively, decreasing to 1.3% (1 of 75) postoperatively. Increasing age and higher preoperative VAS and SF-36 MCS scores were significantly associated with improvements in postoperative AOFAS, SF-36 PCS, and MCS scores.

CONCLUSION

Surgical treatment of IAT via the central tendon-splitting approach achieved substantial improvements in all patient-reported outcome measures measured. These excellent clinical outcomes continued to show improvement 2 years postoperatively.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

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.