Elsevier

The Foot

Volume 21, Issue 3, September 2011, Pages 133-137
The Foot

A longitudinal study of hallux valgus surgical outcomes using a validated patient centred outcome measure

https://doi.org/10.1016/j.foot.2011.01.012Get rights and content

Abstract

Background

: Hallux valgus is a common chronic condition affecting up to a third of the population.

Progressive disruption to the complex anatomy of the first ray involving metatarsal, sesamoids and hallux impose both structural and functional alteration to the foot which underpin the secondary pathologies associated with this condition. It is common for patients to seek correction of the deformity in order to alleviate pain and improve footwear tolerance. Surgical intervention remains the only viable means to restore osseous alignments. To date there remains no universally accepted standards for procedure selection.

Methods

: A total of 179 consecutive participants were recruited into the study. Ethical approval was obtained and all participants consented to participate in the study, in accordance with the Helsinki Declaration. All patients attending the Department of Podiatric Surgery, between July 2004 and October 2007 for the surgical management of hallux valgus were invited to complete a Foot Health Status Questionnaire.

Pre-operative data collection on all participants was undertaken on the day of admission, using the validated Foot Health Status Questionnaire measurement tool as with previous studies.

Results

: A total of 179 complete data sets were recorded in this longitudinal study with an average participant age of 49.4 years (SD 14.5). The group comprised 164 females and 15 males. The mean days for administration of the Foot Health Status Questionnaire post operative follow up was 1045 days (149 weeks or 2.9 years).

The results demonstrated that within all four foot specific domains, the minimal important differences were achieved by the majority of the group. Meanwhile, in domains relating to general health, physical activity, vigour and social capacity, the majority of participants failed to attain the calculated minimal important difference (94 [53%], 96 [54%], 93 [52%], 93 [52%], respectively).

Conclusions

: The authors have presented for the first time minimal important difference for all eight domains for the Foot Health Status Questionnaire quality of life tool in respect to hallux valgus surgery. Results demonstrate that surgical correction of hallux valgus undertaken under local anaesthetic as a Day Case procedure is an effective intervention directly benefiting patients by reducing perceived foot pain, improving foot function and general foot health for the majority of patients.

Section snippets

Background

Hallux valgus is a common chronic condition affecting up to a third of the population [1]. Progressive disruption to the complex anatomy of the first ray involving metatarsal, sesamoids and hallux impose both structural and functional alteration to the foot which underpin the secondary pathologies associated with this condition [2]. It is common for patients to seek correction of the deformity in order to alleviate pain and improve footwear tolerance. Surgical intervention remains the only

Methods

All patients attending the Department of Podiatric Surgery, Solihull Care Trust between July 2004 and October 2007 for the surgical management of hallux valgus were invited to complete a FHSQ survey. Recruitment design was a consecutive case series with decision to treat as part of standard department process. All procedures were undertaken at one of two surgical centres. However, all were performed by the same podiatric surgeon, thus removing potential inter-reliability bias. Post operative

Demographic and global results

A total of 179 complete data sets were recorded in this longitudinal study with an average participant age of 49.4 years (SD 14.5). The group comprised 164 females and 15 males. The mean days for administration of the FHSQ post operative follow up was 1045 days (149 weeks or 2.9 years).

Results for the global anchor question demonstrated that 82 participants (45.8%) perceived their original foot condition was “much better” (Fig. 1). Additionally, a further 86 subjects (48%) reported their

Discussion

Decision making around clinical and surgical interventions should where possible be evidenced based to ensure that the most clinically effective treatment is offered. In today's society the economic burden of healthcare is well recognised and plays a central role in the delivery of many agreed clinical pathways. To date most of the attention has been focused on high cost areas such as drug treatments for cancer and chronic inflammatory joint diseases. Intense scrutiny in many other areas has

Conclusions

The authors have presented for the first time MIDs for all eight domains for the FHSQ quality of life tool in respect to hallux valgus surgery. Results demonstrate that surgical correction of hallux valgus undertaken under local anaesthetic as a Day Case procedure is an effective intervention directly benefiting patients by reducing perceived foot pain, improving foot function and general foot health for the majority of patients.

Competing interests

The authors declare that they have no significant competing financial, professional or personal interests that might have influenced the performance or presentation of the work described in this manuscript.

Authors’ contributions

SAM carried out the data collection and surgical interventions. MCS conducted the data analysis. MCS, FLB and SAM contributed to the papers construction, read and approved the final manuscript.

Acknowledgements

The authors wish to thank Dr Alan Borthwick for his help and advice in compiling this manuscript.

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    These authors contributed equally to this work.

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