The impact of hallux valgus on function and quality of life in females

Revision of Recurrent Hallux Valgus Deformity Using a Percutaneous Distal Transverse Osteotomy: Surgical Considerations and Early Results

Hallux valgus (HV) is a common forefoot deformity that can cause pain and difficulty with walking. There are a range of surgical techniques to treat HV deformity, but there is a risk of recurrence. This article reviews the clinical assessment and management of recurrent HV as well as a detailed description of how percutaneous surgical techniques can be used to treat recurrent HV. Overall, percutaneous surgical techniques using a transverse osteotomy and distal screw fixation can successfully treat a wide range of recurrent deformity severities with significant improvement in clinical and radiographic outcomes.

The Learning Curve in Hallux Valgus Surgery

For any surgical technique, the learning curve is the number of times a particular procedure must be undertaken in order to complete it repeatedly with high accuracy and proficiency. Scientifically, a difficult task to master is represented by a flat learning curve, as the steep portion of the learning curve would correlate with rapid learning. Today, there's more literature on the learning curve of percutaneous HV surgery than on any other procedure in foot and ankle surgery. Due to the lack of conclusive research on traditional HV techniques, no comparison to modern percutaneous techniques is possible. The current literature suggests that it takes between 30-40 cases to gain sufficient proficiency in 3rd generation percutaneous hallux valgus correction.

The Inaugural UK National Hallux Valgus Think Tank : identification of key issues and strategies to improve clinical care for patient benefit

Aims

Hallux valgus (also known as a bunion) is a common forefoot deformity impacting pain, function, quality of life, and mobility, with higher prevalence in females and increasing incidence with age. The high prevalence and rates of surgical treatment potentially have a major impact on the healthcare system. The aim of this stakeholder consultation was to identify current issues with provision of hallux valgus treatment, as well as identify achievable goals to improve understanding of hallux valgus and guide future assessment, treatment pathways, and research directions with the aim of improving clinical outcomes for patients.

Methods

Scoping searches were undertaken to inform and identify relevant outcome sets and existing evidence relating to hallux valgus. A one-day think tank conference was held on 21 June 2024, involving stakeholders from various sectors, including patients, primary and secondary care professionals, researchers, and representatives of national societies. Key themes and issues related to hallux valgus were identified and used to develop structured action development plans.

Results

Major issues identified include the absence of national policy recommendations, variability in treatment pathways, and gaps in research and patient education. Patient experiences highlighted the significant impact on quality of life and the need for standardized information and care pathways. Key priorities for research include developing a core outcome set and understanding the patient's lived experience, while policy priorities focus on creating national guidelines and raising awareness of the condition's socioeconomic and functional impacts.

Conclusion

The inaugural UK National Hallux Valgus Think Tank identified critical issues in the management of hallux valgus and developed strategies to improve clinical outcomes through research and policy development. Establishing a working group and prioritizing both research and policy initiatives will be essential to advancing the understanding and treatment of hallux valgus.

Research progress in the etiology and minimally invasive therapy of hallux valgus

Hallux valgus (HV) is the most common foot deformity. It has various pathogenic factors that make its pathogenesis challenging to understand. As the disease progresses, patients experience amplified pain and decreased activities, significantly affecting their quality of life. At present, clinics offer several conservative and surgical treatments that must be selected based on patient condition and disease progression. Surgical treatment is frequently the only method available to patients with HV to delay disease progression and correct the deformity after conservative treatment fails. In recent years, minimally invasive surgical treatments have gained significant attention and developed rapidly due to their well-known advantages, such as safety, efficiency, and quick recovery time. The number of literature that provides a systematic review of the subject must be increased. This review tracks recent advancements, summarizing the etiological mechanism, epidemiology, diagnosis, and treatment of HV. In addition, it emphasizes typical surgical therapies and focuses on the progress of minimally invasive treatment from the first generation to the current fourth generation. This review will serve as a systematic basis for the clinical treatment of HV and provide a reference material for future research.

Subtalar arthroereisis for simultaneous treatment of flexible pes planus during surgical correction of hallux valgus

BACKGROUND

Scarf osteotomy is a well-established procedure for hallux valgus, yet recurrence rates range from 3.6% to 10%. Pes planus, which often coexisting with hallux valgus, is a risk factor for recurrence. This study aimed to evaluate the effectiveness of simultaneous correction of hallux valgus and flexible pes planus.

METHODS

A total of 85 feet with hallux valgus associated with adult flexible pes planus were retrospectively reviewed. All patients were treated with scarf osteotomy (SO). Subtalar arthroereisis using a HyProCure implant (SOH) was performed to correct hindfoot valgus based on shared decision-making. We collected and compared pre- and at least 2 year postoperative clinical outcomes (American Orthopaedic Foot & Ankle Society (AOFAS) forefoot, hindfoot score, Visual Analog Scale (VAS) pain intensity) and radiographic outcomes (hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, talonavicular coverage angle (TNCA), and calcaneal pitch (CP) angle in both groups.

RESULTS

Of the cases reviewed, 51 feet were allocated to SO group, and 34 feet were in SOH group. Recurrence frequency was 5 feet (9.8%) in the SO group, while no recurrences were reported in the SOH group. There was no significant difference in AOFAS forefoot and VAS scores between the groups, However, the SOH group demonstrated significant improvement in AOFAS hindfoot scores and CP angle, as well as a greater reduction in Meary's angle and TNCA, compared to the SO group. Changes in HVA and IMA did not differ significantly between the groups. Three feet in the SOH group experienced sinus tarsi pain, which resolved after removal of the HyProCure implant.

CONCLUSIONS

Subtalar arthroereisis with a HyProCure implant is an effective treatment option for adult flexible pes planus associated with scarf osteotomy for hallux valgus, leading to a steady improvement in the patients forefoot deformity and increased patient satisfaction at least 2 years postoperatively.

The association between varus knee deformity and morphological changes in the foot and ankle in patients with end-stage varus knee osteoarthritis

BACKGROUND

This study aimed to (1) determine the association between varus knee deformity and ipsilateral foot and ankle morphology, and (2) evaluate the relationship between varus knee deformity and foot and ankle pain in patients with end-stage varus knee osteoarthritis (KOA).

METHODS

A total of 213 patients who underwent primary total knee arthroplasty for end-stage varus KOA were enrolled in this study and divided into a 'severe varus group' (n = 119) and a 'mild varus group' (n = 94) based on preoperative knee varus degree. Morphological parameters and pain incidence in the foot and ankle were compared between the two groups. The correlation between knee varus and foot and ankle morphology was analyzed.

RESULTS

Significant differences in ankle morphology were observed between the two groups. The deformity magnitudes of the hindfoot valgus (P < 0.001) and hallux valgus (HVA, P = 0.028; IMA, P = 0.046) were significantly higher in the severe varus group. Additionally, the incidences of ankle osteoarthritis (OA) (P = 0.005) and hallux valgus (P = 0.028) were higher in the severe varus group. Patients with severe KOA were more likely to experience medial ankle pain (P = 0.023), hindfoot pain (P = 0.034), and multiple pain locations (P = 0.015).

CONCLUSION

Varus knee deformity was associated with morphological changes in the foot and ankle, and the incidence of ankle OA and hallux valgus deformity was significantly higher in patients with severe varus KOA. Patients with severe varus KOA were more prone to medial ankle pain, hindfoot pain, and multiple pain locations, which were associated with corresponding morphological changes.

Current concepts of fourth-generation minimally invasive and open hallux valgus surgery

Hallux valgus (HV) presents as a common forefoot deformity that causes problems with pain, mobility, footwear, and quality of life. The most common open correction used in the UK is the Scarf and Akin osteotomy, which has good clinical and radiological outcomes and high levels of patient satisfaction when used to treat a varying degrees of deformity. However, there are concerns regarding recurrence rates and long-term outcomes. Minimally invasive or percutaneous surgery (MIS) has gained popularity, offering the potential for similar clinical and radiological outcomes with reduced postoperative pain and smaller scars. Despite this, MIS techniques vary widely, hindering comparison and standardization. This review evaluates the evidence for both open Scarf and Akin osteotomy and newer-generation MIS techniques. Fourth-generation MIS emphasizes multiplanar rotational deformity correction through stable fixation. While MIS techniques show promise, their evidence mainly comprises single-surgeon case series. Comparative studies between open and MIS techniques suggest similar clinical and radiological outcomes, although MIS may offer advantages in scar length and less early postoperative pain. MIS may afford superior correction in severe deformity and lower recurrence rates due to correcting the bony deformity rather than soft-tissue correction. Recurrence remains a challenge in HV surgery, necessitating long-term follow-up and standardized outcome measures for assessment. Any comparison between the techniques requires comparative studies. Surgeons must weigh the advantages and risks of both open and MIS approaches in collaboration with patients to determine the most suitable treatment.

Comparison of the effects of orthoses on hallux valgus angle and plantar pressure in individuals with hallux valgus

BACKGROUND

Hallux valgus (HV) is a condition characterized by the lateral deviation of the first phalanx and medial deviation of the first metatarsal, leading to subluxation of the first metatarsophalangeal joint. Various orthotic applications are employed in the treatment of HV deformity. This study aimed to compare the effects of a toe separator (TS) and dynamic orthosis (DO) on hallux valgus angle (HVA), plantar pressure (PP), and quality of life (QoL).

METHODS

Thirty individuals aged between 18 and 65 years who had mild to moderate HV deformity were included in our study. Participants were randomized into TS and DO groups. Pretest and post-test evaluations at 4 weeks included goniometric measurement for HVA, PP measurement using the Sensor Medica device, QoL assessment using the American Orthopaedic Foot & Ankle Society-Hallux MTP-IP Scale and Manchester-Oxford Foot Questionnaire, and numerical evaluation scale for orthosis satisfaction.

RESULTS

No statistically significant changes were observed in HVA measurements (p > 0.05). In the DO group, significant differences were observed in PP assessment for right rearfoot loading (p = 0.048) and total average pressure measurement of the right foot (p = 0.025). QoL assessments were observed significant differences in the DO group compared with the TS group (p < 0.05).

CONCLUSIONS

After a 4-week period of wearing the TS and DO orthoses, no change in HVA was observed. In the DO group, a more balanced load distribution between the right and left foot (50.2% left, 49.8% right) and a more pronounced effect in reducing deformity-related pain and improving QoL by increasing functionality were noted.

Association of calcaneal pitch angle with recurrence of postoperative hallux valgus in patients with rheumatoid arthritis

Hallux valgus (HV) and flatfoot deformities are frequently seen in patients with rheumatoid arthritis (RA). This study aimed to determine whether flatfoot deformity contributes to the recurrence of HV in RA patients. This study examined 62 feet from 45 RA patients who were diagnosed with HV and underwent the first metatarsal joint-preserving surgery between November 2010 and October 2021. Recorded data included age at surgery, sex, disease duration, body mass index [BMI], RA disease duration, medical treatment of RA, Larsen grade, blood test, pre/postoperative Japanese Society for Surgery of the Foot, HV angle, M1M2 angle, M1M5 angle, calcal pitch angle, and Meary's angle. HV recurrence on radiography was defined as an HV angle exceeding 20°. HV recurrence was observed in 17 feet. Significant differences were observed due to risk factors such as BMI, disease duration, Larsen grade 4-5, and preoperative calcaneal pitch angle. Multivariate logistic regression analysis identified that lower BMI, a higher M1M2 angle, and a lower calcaneal pitch angle are preoperative risk factors for the recurrence of postoperative HV in RA patients. LEVEL OF EVIDENCE: 3.

Predictors of poor pre-operative patient reported outcome measures in elective foot and ankle surgery: Analysis of 1217 patients

AIMS

Patient reported outcome measures (PROMs) have become the de facto measure of success in orthopaedic publications. It has been established that preoperatively collected patient reported outcomes correlate with post-operative outcome. The aim of our research is to identify which factors predict poor pre-operative scores using the most commonly used PROMs.

METHODS

MOXFQ and EQ-5D scores were collected for all patients presenting for elective foot and ankle surgery over a four-year period from June 2018 to February 2022. Multivariate linear regression calculated associations between PROMs and demographics, diagnosis, pre-operative appointments and comorbidities.

RESULTS

1217 patients had PROMs taken, 1102 of these underwent a surgical procedure. Ankle and hindfoot arthritis predicted worse pre-operative scores. Total comorbidity number, depression/anxiety, younger patients, female gender and preoperative appointments with orthotist predicted a worse outcome score.

CONCLUSION

Underlying patient characteristics can influence pre-operative PROMs in foot and ankle surgery.

Effects of 4 weeks of foot exercise on subjective outcome and foot plantar pressure in elite adolescent dancers with hallux valgus: a pilot study

BACKGROUND

Dancers have a higher prevalence of hallux valgus (HV) than the general population. However, no reports specifically addressing treatment strategies for HV in dancers, or their effectiveness have been published. This study aimed to determine the effects of 4 weeks of foot exercises on subjective clinical outcomes, the HV angle, and change of foot plantar pressure during specific dance techniques.

METHODS

Thirteen female elite adolescent dancesport athletes (age: 16.4 ± 3.3 years) completed the program. The HV angle was measured based on foot photographs. Clinical assessments were performed using the visual analog scale for first metatarsophalangeal (1st MTP) joint pain, and the Foot and Ankle Outcome Score. The changes in plantar pressure during two dance techniques (demi-pointe and plié) were measured. The plantar pressure was measured in six areas of the foot. All of these parameters were compared before and after the intervention by using chi-square tests and Student's paired t-test (statistical significance: p < 0.05).

RESULTS

The HV angle was significantly reduced from 20.1° to 15.4° after the intervention. Participants reported an average subjective completion rate of 70.3% ± 14.6% over 3 weeks, exhibiting no significant differences despite an apparent trend toward improvement. Significant changes were noted in 1st MTP joint pain and subjective outcomes, and toe function significantly improved in the "paper" movement. The foot-exercise program changed plantar pressure distribution during the demi-pointe and plié techniques, with increased hallux pressure and decreased 2nd-5th MTP joint pressure.

CONCLUSIONS

In elite adolescent dancesport athletes, 4 weeks of foot-exercise rehabilitation reduced the HV angle and improved in subjective outcome and function during the two dance techniques. Coaches should consider utilizing foot-exercise training programs in a dancer training program for HV.

Hallux valgus in preprofessional adolescent dancesport athletes: Prevalence and associated training factors

BACKGROUND

This study aimed to determine the risk factors of hallux valgus angle among preprofessional adolescent dancesport athletes.

METHODS

A total of 275 athletes, (73 males and 202 females) aged between the ages of 11 and 18 years, participated in this study. A cross-sectional questionnaire was used to survey their demographic characteristics (sex and age), training information (starting age, weekly training time, and athletic career [number of years of training at this specific dancesport school]), and measured their height and weight. The hallux valgus angle was measured based on foot photographs. The chi-square test was used to compare the difference with prevalence of hallux valgus between male and female athletes. A normal distribution test was performed, and based on the test results, unpaired t-test and multiple logistic regression were conducted to identify training factors for the hallux valgus in this cohort.

RESULTS

Chi-square test showed higher prevalence of hallux valgus in female elite adolescent dancesport athletes than males. The t-test results did not show any significant differences between the hallux valgus group and non-hallux valgus groups with start age, athletic career, and weekly training time. Multiple logistic regression analysis with hallux valgus as the dependent variable revealed that the female sex was a strong predictor of a higher prevalence of hallux valgus (odds ratio [OR]: 3.954, 95% confidence interval 95% CI: 2.193-7.131, and p < 0.001). Weekly training time was also entered into the multiple logistic regression model (OR: 1.033, 95% CI: 1.001-1.067, and p = 0.041).

CONCLUSIONS

Our findings revealed that the prevalence of hallux valgus in adolescent dancesport athletes was higher in females than in males. Longer weekly training time was also a risk factor for hallux valgus. Training factors should be considered in preventive programs for elite adolescent dancesport athletes, and special attention should be paid to female athletes.

Surgical interventions for treating hallux valgus and bunions

BACKGROUND

Hallux valgus (lateral angulation of the great toe towards the lesser toes, commonly known as bunions) presents in 23% to 35% of the population. This condition leads to poor balance and increases the risk of falling, adding to the difficulty in fitting into shoes and pain. Conservative (non-surgical) interventions treating pain rather than curing deformity are usually first-line treatments. When surgery is indicated, the overall best surgical procedure is an ever-evolving topic of discussion.

OBJECTIVES

To assess the benefits and harms of different types of surgery compared with placebo or sham surgery, no treatment, non-surgical treatments and other surgical interventions for adults with hallux valgus.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and trial registries to 20 April 2023. We did not apply any language or publication restrictions.

SELECTION CRITERIA

We included randomised controlled trials evaluating surgical interventions for treating hallux valgus compared to placebo surgery or sham surgery, no treatment, non-surgical treatment or other surgical interventions. The major outcomes were pain, function, quality of life, participant global assessment of treatment success, reoperation (treatment failure), adverse events and serious adverse events.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and the certainty of evidence using GRADE.

MAIN RESULTS

We included 25 studies involving 1597 participants with hallux valgus. All studies included adults and most were women. One study compared surgery (V-shaped osteotomy) with no treatment and with non-surgical treatment. Fifteen studies compared different surgical techniques, including a V-shaped osteotomy (Chevron osteotomy), to other types of osteotomy. Nine studies compared different simple osteotomy techniques to each other or to a mid-shaft Z-shaped osteotomy (Scarf osteotomy). Most trials were susceptible to bias: in particular, selection (80%), performance (88%), detection (96%) and selective reporting (64%) biases. Surgery versus no treatment Surgery may result in a clinically important reduction in pain. At 12 months, mean pain was 39 points (0 to 100 visual analogue scale, 100 = worst pain) in the no treatment group and 21 points in the surgery group (mean difference (MD) -18.00, 95% confidence interval (CI) -26.14 to -9.86; 1 study, 140 participants; low-certainty evidence). Evidence was downgraded for bias due to lack of blinding and imprecision. Surgery may result in a slight increase in function. At 12 months, mean function was 66 points (0 to 100 American Orthopedics Foot and Ankle Scale (AOFAS), 100 = best function) in the no treatment group and 75 points in the surgery group (MD 9.00, 95% CI 5.16 to 12.84; 1 study, 140 participants; low-certainty evidence). Evidence was downgraded for bias due to lack of blinding and imprecision. Surgery may result in little to no difference in quality of life. At 12 months, mean quality of life (0 to 100 on 15-dimension scale, 100 = higher quality of life) was 93 points in both groups (MD 0, 95% CI -2.12 to 2.12; 1 study, 140 participants; low-certainty evidence). Evidence was downgraded for bias due to lack of blinding and imprecision. Surgery may result in a slight increase in participant global assessment of treatment success. At 12 months, mean participant global assessment of treatment success was 61 points (0 to 100 visual analogue scale, 100 = completely satisfied) in the no treatment group and 80 points in the surgery group (MD 19.00, 95% CI 8.11 to 29.89; 1 study, 140 participants; low-certainty evidence). Evidence was downgraded for bias due to lack of blinding and imprecision. Surgery may have little effect on reoperation (relative effect was not estimable), adverse events (risk ratio (RR) 8.75, 95% CI 0.48 to 159.53; 1 study, 140 participants; very low-certainty evidence), and serious adverse events (relative effect was not estimable), but we are uncertain. Surgery versus non-surgical treatment Surgery may result in a clinically important reduction in pain; a slight increase in function and participant global assessment of treatment success; and little to no difference in quality of life (1 study, 140 participants; low-certainty evidence). We are uncertain about the effect on reoperation, adverse events and serious adverse events (1 study, 140 participants; very low-certainty evidence). Complex versus simple osteotomies Complex osteotomies probably result in little to no difference in pain compared with simple osteotomies (7 studies, 414 participants; moderate-certainty evidence). Complex osteotomies may increase reoperation (7 studies, 461 participants; low-certainty evidence), and may result in little to no difference in participant global assessment of treatment success (8 studies, 462 participants; low-certainty evidence) and serious adverse events (12 studies; data not pooled; low-certainty evidence). We are uncertain about the effect of complex osteotomies on function and adverse events (very low-certainty evidence). No study reported quality of life.

AUTHORS' CONCLUSIONS

There were no trials comparing surgery to placebo or sham. Surgery may result in a clinically important reduction in pain when compared to no treatment or non-surgical treatment. Surgery may also result in a slight increase in function and participant global assessment of treatment success compared to no treatment or non-surgical treatment. There may be little to no difference in quality of life between surgery and no treatment or non-surgical treatment. We are uncertain about the effect of surgery on reoperation (treatment failure), adverse events or serious adverse events, when compared to no treatment or non-surgical treatment. Complex and simple osteotomies demonstrated similar results for pain. Complex osteotomies may increase reoperation (treatment failure) and may result in little to no difference in participant global assessment of treatment success and serious adverse events compared to simple osteotomies. We are uncertain about the effect of complex osteotomies on function, quality of life and adverse events.

First tarsometatarsal arthrodesis for severe hallux valgus using the tension band principle - Technical tip and case series

BACKGROUND

Hallux valgus (HV) is a common foot pathology. Severe HV in the presence of Tarsometatarsal joint (TMTJ) instability is often managed with arthrodesis of the 1st TMTJ. There are concerns regarding non-union and malunion (particularly the early loss of inter-metatarsal angle correction before complete arthrodesis). We report our medium-term results of a small series of patients that underwent an evolved surgical technique utilising orthogonal staples and a transverse suture button fixation to address biomechanical concerns with traditional Lapidus arthrodesis.

METHODS

A retrospective study of a consecutive series of patients who underwent this surgical technique between February 2017 and May 2022. Clinical outcomes were validated through Patient-reported outcomes measures (PROMS); EuroQol-5 Dimension (EQ-5D) and Manchester-Oxford Foot Questionnaires (MOXFQ). Radiographic parameters (hallux valgus (HVA), intermetatarsal (IMA), distal metatarsal articular angle (DMAA)) were assessed. Union of the arthrodesis and complications were recorded.

RESULTS

During the study period, 9 feet underwent the procedure. Radiographic data was available for all nine and PROMS data for seven (77.8%). Significant improvement occurred in all radiographic deformity parameters at mean 6-month follow-up. Mean ± standard deviation correction calculated preoperatively as HVA 40.2°, IMA 19.3° and DMAA 15.8°, corrected to HVA 15.4°, IMA 5.8° and DMAA 5.9° postoperatively. (HVA; P < 0.001, IMA; P < 0.001, DMAA; P < 0.001) Clinical PROMs at mean follow-up of 2 years were MOXFQ 34.4 ± 25.2, EQ-5D-5 L 0.819 ± 0.150 and VAS pain 13.6 ± 13.6. There were no cases of non-union, Tibialis anterior tendon irritation or hallux varus. Complications included first MTPJ stiffness in one case and CRPS and dorsiflexion malunion of the first ray in another patient.

CONCLUSION

This preliminary study of the procedure used in this series confirm this is a safe surgical technique to address severe HV with a low rate of non-union and significant radiographic improvements. A larger patient dataset is needed to evaluate this procedure robustly.

Cross-cultural adaptation and validation of a Spanish version of the self-administered foot evaluation questionnaire (SAFE-Q)

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.

Lived experience of people with painful hallux valgus: A descriptive qualitative study

OBJECTIVE

Hallux valgus has a detrimental impact on health-related quality of life. Education is crucial for the management of all musculoskeletal conditions, although no previous research has evaluated the sources and quality of education accessed by patients with hallux valgus. Therefore, we aimed to evaluate the perceptions and attitudes of individuals with hallux valgus, including their educational experiences.

METHODS

A qualitative descriptive design was employed to gather data from individuals diagnosed with painful hallux valgus. Semi-structured interviews explored the perceptions, attitudes and educational experiences of participants. Interviews were recorded, transcribed verbatim, and analysed using the Framework Method. Respondent validation was used to ensure the rigour of the study findings.

RESULTS

Ten participants were interviewed, ages 26-72. Data analysis revealed five themes including the impact of hallux valgus, coping with hallux valgus, cause of hallux valgus, health professional support and education received. Hallux valgus was associated with a negative impact on health-related quality of life. Participants described a lack of high quality, accurate and reliable educational resources, and a variable experience with health professionals, which was often characterised by a lack of engagement and commitment and an overemphasis of referrals for specialist opinion.

CONCLUSION

Hallux valgus has a negative influence on well-being, including physical, mental, and social impacts. Health professionals should be responsive to patient needs and strive to implement person-centred care when indicated. There is also a need for the development of high-quality educational resources to help people with hallux valgus make informed decisions about their condition.

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.

Effects of custom insoles for symptomatic hallux valgus: protocol for a sham-controlled randomised trial

INTRODUCTION

Hallux valgus (HV) is one of the most prevalent forefoot deformities, and its frequency increases with age, reaching nearly 23% in adulthood (females are usually more affected). Studies on customised insoles and orthoses for HV showed inconclusive results. There is no consensus in literature regarding the ideal insole or length of use for pain relief or functional improvement in individuals with HV. This study will assess the effects of a customised insole with retrocapital bar associated with an infracapital bar of the first metatarsal on pain and function of individuals with symptomatic HV.

METHODS

This is the protocol for a blinded, sham-controlled randomised clinical trial. Eighty participants with symptomatic HV will be randomised into two groups (40 per group): customised insole or sham insole. Assessments will be performed at baseline (T0), six (T6) and 12 weeks (T12) of intervention. A follow-up will occur after 4 weeks of intervention (T16). The primary and secondary outcomes will be pain (Numerical Pain Scale) and function (Foot Function Index), respectively.

STATISTICAL ANALYSIS

Analysis of variance with a mixed design or Friedman's test will be considered according to data distribution; post-hoc analyses will be performed using Bonferroni test. Time × group interaction and within-group and between-group differences will also be assessed. The intent-to-treat analysis will be used. A significance level of 5% and 95% s will be adopted for all statistical analyses.

ETHICS AND DISSEMINATION

This protocol was approved by the research ethics committee of the Faculty of Health Sciences of Trairi/Federal University of Rio Grande do Norte (UFRN/FACISA; opinion number 5411306). The study results will be disseminated to participants, submitted to a peer-reviewed journal and presented in scientific meetings.

TRIAL REGISTRATIONS NUMBER

NCT05408156.

Temporal Changes in Clinical Outcomes after Minimally Invasive Surgery for Hallux Valgus Correction in Women without Postoperative Complications

Minimally invasive surgery (MIS) is currently used to correct hallux valgus deformities. Most studies reporting on MIS techniques to correct hallux valgus deformities included patients with postoperative complications. These reported complications, with an average rate of 23%, had significant negative effects on the clinical outcomes in this patient population. In the present study, a cohort of 63 women who underwent MIS hallux valgus correction was assessed preoperatively and at a mean follow-up of 1.0, 4.7, and 6.5 years using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Manchester Oxford Foot Questionnaire (MOXFQ). The main criterion for inclusion in this cohort was a lack of complications during the entire follow-up period. The results showed significant improvements in both AOFAS and MOXFQ scores between the preoperative and 1-year follow-up assessments. By contrast, clinically small and nonsignificant changes were observed among postoperative follow-up values. The number of enrolled patients needs to be increased in future studies, with different surgeons and techniques included. Nevertheless, our study findings will inform patients about the outcomes they can expect over the years if no complications occur.

Five-Year Follow-up of Third-Generation Percutaneous Chevron and Akin Osteotomies (PECA) for Hallux Valgus

BACKGROUND

Recent large studies of third-generation minimally invasive hallux valgus surgery (MIS) have demonstrated significant improvement in clinical and radiologic outcomes. It remains unknown whether these clinical and radiologic outcomes are maintained in the medium to long term. The aim of this study was to investigate the minimum 5-year clinical and radiologic outcomes following third-generation MIS hallux valgus surgery in the hands of a high-volume MIS surgeon.

METHODS

A retrospective observational single highly experienced MIS surgeon case series of consecutive patients undergoing primary isolated third-generation percutaneous chevron and Akin osteotomies (PECA) for hallux valgus with a minimum 60-month clinical and radiographic follow-up. Primary outcome was radiographic assessment of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) preoperatively, 6 months, and ≥60 months following PECA. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, patient satisfaction, EuroQol-5D visual analog scale and the visual analog scale for pain.

RESULTS

Between 2012 and 2014, 126 consecutive feet underwent isolated third-generation PECA, with complete data available for 78 (61.9%) feet. The median follow-up was 65.0 (IQR 64-69; range 60-88) months. There was a significant improvement in radiographic deformity correction; the median IMA improved from 12.0 degrees (interquartile range [IQR]: 10.8-14.2) to 6.0 degrees (IQR: 4.2-7.3) (P < .001), and the median HVA improved from 27.2 degrees (IQR: 20.6-34.4) to 7.2 degrees (IQR: 3.4-11.6). Median MOXFQ Index score at ≥60-month follow-up was 2.3 (IQR: 0.0-7.8). The radiographic recurrence rate (defined as HVA >15 degrees) was 7.7% at final follow-up. The complication rate was 4.8%.

CONCLUSION

Radiologic deformity correction for the 78 feet we were able to follow that had third-generation PECA performed by a single highly experienced MIS surgeon was found to be maintained at a mean follow-up of average 66.8 months, with a radiographic recurrence rate of 7.7%. Clinical PROMs and patient satisfaction levels were high and comparable to other third-generation studies with shorter duration of follow-up.

LEVEL OF EVIDENCE

Level IV, retrospective cohort study.