Responsiveness of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) in patients with hallux valgus

Effect of simultaneous bilateral surgery or simultaneous arthroscopic ankle lateral ligament repair in hindfoot endoscopic surgery for posterior ankle impingement syndrome in athletes

BACKGROUND

Posterior ankle impingement syndrome (PAIS) is sometimes complicated by bilateral cases and lateral ankle ligament injuries. Reports on bilateral surgery for PAIS and simultaneous surgery for lateral ankle ligament injury are scarce in the literature.

METHODS

We present a 2-year follow-up of 76 athletic patients who underwent endoscopic hindfoot surgery for PAIS. Patients were divided into those who underwent unilateral or simultaneous bilateral surgery and PAIS surgery alone or simultaneous bilateral PAIS surgery without arthroscopic ankle lateral ligament repair.

RESULTS

All patients returned to full athletic activities postoperatively. There was no difference in all subscales of the SAFE-Q score between groups except for mean days after surgery for full return to athletic activities.

CONCLUSION

Simultaneous bilateral surgery and simultaneous arthroscopic lateral ankle ligament repair had no negative effect on subjective clinical evaluation 2 years after surgery in hindfoot endoscopic surgery for PAIS.

LEVEL OF EVIDENCE

III, retrospective case-control study.

Nonunion of Isolated Medial Cuneiform Fracture Fixed With a Compression Screw and Compression Staple: A Case Report

Isolated cuneiform fractures are rare and account for only 1.7% of all midfoot fractures. Medial cuneiform fractures can be treated conservatively or surgically, with good clinical outcomes. However, nonunion is a rare complication of medial cuneiform fractures, and only a few cases have been reported in the literature. We report a case of a medial cuneiform fracture requiring surgical treatment that had a good clinical outcome. A 15-year-old boy presented to an orthopedic clinic with a complaint of pain in his right foot. The patient had landed on the foot during a handball game and was treated conservatively for several months. However, his symptoms persisted, and he was referred to our clinic for further evaluation, where he was diagnosed with medial cuneiform nonunion of the right foot. Open reduction and internal fixation surgery using a compression screw and staple and autologous bone grafting were performed. Postoperatively, bone union was observed, and the patient returned to full competition with no complaints of pain during exercise. The Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score at 21 months after surgery was 100.0 for the following subscales: Pain & Pain-Related; Physical Functioning & Daily Living; Social Functioning; Shoe-Related; General Health & Well-Being; and Sport (handball). We encountered a case of an isolated medial cuneiform fracture that required surgical treatment. During the surgical treatment, fixation with a combination of compression staples and screws may be considered simple and useful for achieving strong fixation because the medial cuneiform fracture has a small bone fragment.

Arthroscopic Modified Lasso-Loop Stitch Technique for Chronic Lateral Ankle Instability in Skeletally Immature vs Mature Patients

BACKGROUND

In recent years, arthroscopic lateral ankle ligament repair has become increasingly popular. However, reports on the clinical outcomes of arthroscopic ankle stabilization for skeletally immature patients remain scarce. This study investigated the clinical outcomes of arthroscopic lateral ankle ligaments repair in skeletally immature patients compared to skeletally mature patients.

METHODS

Our retrospective analysis compared skeletally immature patients and skeletally mature adults who underwent arthroscopic repair of the ankle lateral ligaments with a modified lasso-loop stitch using a suture anchor. Skeletal immaturity was defined as patients whose epiphyseal line of the distal fibula remained open on plain radiography. Clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) at 2 years after surgery. The time to postoperative walking, jogging, and return to full sports activities were also evaluated.

RESULTS

Sixty-four skeletally immature patients (IM group) and 103 skeletally mature adults (M group) were included. No significant differences were observed during both walking and jogging after surgery between the groups; however, return to full athletic activities was significantly earlier in IM group (P = .05). The mean scores in all SAFE-Q subscales significantly improved in both groups after surgery (P < .001). There were also no statistically significant differences between the groups in the mean postoperative SAFE-Q scores for all subscales. All patients in the IM group returned to playing sports at their preinjury levels postoperatively.

CONCLUSION

We found that skeletally immature patients with chronic lateral ankle instability had generally similar responses to arthroscopic lateral ankle as skeletally mature adult patients at minimally 2 years' follow-up with a high rate of successful return to sport.

LEVEL OF EVIDENCE

Level III, retrospective case control study.

Outcomes of Joint-Preserving Surgery for Forefoot Deformities in Patients With Rheumatoid Arthritis

BACKGROUND

With the advent of effective disease-modifying medications, the surgical treatment of forefoot deformities in patients with rheumatoid arthritis (RA) has evolved from joint-sacrificing to joint-preserving surgery. However, it is unclear whether joint-preserving surgery is effective for the full range of metatarsophalangeal joint involvement. Hence, this study investigated the postoperative outcomes of joint-preserving surgery for rheumatoid forefoot deformities with a wide range of joint destruction.

METHODS

This retrospective observational study included 68 feet from 68 patients with RA who underwent joint-preserving surgery for forefoot deformities between 2014 and 2020. The Larsen grade classification was used to assess the first metatarsophalangeal joint destruction and classify patients into 4 groups as follows: 0 and 1 (n = 14), 2 (n = 21), 3 (n = 19), and 4 and 5 (n = 14). The Self-Administered Foot and Ankle Evaluation Questionnaire (SAFE-Q) score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were determined before surgery and at the last follow-up visit.

RESULTS

The median observation duration was 40 (range, 24-78) months. SAFE-Q scores of all groups significantly improved in all subscales at the last observation, with no significant differences among the study groups. Radiographic evaluations of all groups revealed significant improvements in HVA and IMA after surgery, with no significant differences among the groups.

CONCLUSION

In patients using the surgical approaches described in this study, joint-preserving surgery for rheumatoid forefoot deformities led to satisfactory clinical and radiographic improvements, regardless of the severity of joint destruction.

LEVEL OF EVIDENCE

Level III, case-control study.

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.

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.

Arthroscopic Fixation Using Bioabsorbable Pins With Bone Grafting via a Medial Malleolus Approach to Treat Osteochondral Lesion of the Talus

Fixation of the osteochondral fragment has the advantage to restore the naturally congruent morphology of the talar dome with native hyaline cartilage in the treatment of the osteochondral lesion of the talus (OLT). Surgical treatment of medial talar osteochondral lesions is commonly done through a medial malleolar osteotomy. However, a medial malleolar osteotomy is an invasive procedure and gives negative impacts on clinical outcomes. Fixation for the posteromedial lesion of the OLT without the medial malleolar osteotomy may provide good clinical outcomes. We showed arthroscopic fixation for medial OLT without the medial malleolar osteotomy. Curettage and bone grafting between the fragment and its bed were performed, and then 2-mm bone tunnel in the medial malleolus was created. Bioabsorbable pins were inserted through the tunnel to fix the osteochondral fragment. Three cases (mean age 18.6 years) were treated using this technique for medial OLT and followed at 16 months (range, 12-24 months). The Japanese Society for Surgery of the Foot scale improved from 73.3 ± 1.2 points before surgery to 95.7 ± 7.5 points at the final follow-up. Bone union of the osteochondral fragment was confirmed on magnetic resonance imaging (MRI). Arthroscopic fixation for medial OLT is less invasive and yields good clinical outcomes.Levels of Evidence: Level V.

Operative outcomes of hallux valgus with painful osteoarthritis of the lesser tarsometatarsal joints

BACKGROUND

Hallux valgus is sometimes accompanied by osteoarthritis of the lesser tarsometatarsal joint. However, information on the operative procedures and outcomes for the treatment of hallux valgus with osteoarthritis of the lesser tarsometatarsal joint simultaneously is limited. We aimed to describe this operative procedure and evaluate the outcomes of the treatment of hallux valgus with osteoarthritis of the lesser tarsometatarsal joint.

METHODS

Fifteen patients (17 feet; average age, 66.9 years; average follow-up, 59.4 months; and minimum follow-up, 24 months) with symptomatic hallux valgus accompanied by painful osteoarthritis of the lesser tarsometatarsal joint were enrolled. All feet showed osteoarthritis of the second and/or third tarsometatarsal joint on dorsoplantar weight-bearing radiograph. The operative procedure included a proximal osteotomy of the first metatarsal and arthrodesis of the lesser tarsometatarsal joint with an autologous bone graft.

RESULTS

The mean Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal score significantly improved from 54.8 points preoperatively to 91.7 points postoperatively (P <0.001). The mean postoperative visual analog score (15 feet) was 1.0 (0-3.9). Preoperative midtarsal pain disappeared in 14 feet and decreased in one foot postoperatively. Preoperative metatarsalgia was found in five feet, of which, it disappeared in two feet, decreased in two feet, and transferred to another region in one foot at the latest follow-up. The mean hallux valgus and intermetatarsal angles were 42.4° and 18.4° preoperatively, which decreased significantly to 12.5° and 6.9° postoperatively, respectively (P <0.001, all). Recurrence of hallux valgus (hallux valgus angle ≥20°) was observed in two feet (11.8%). Nonunion of the third tarsometatarsal joint was observed in one foot (3.1% among 32 joints).

CONCLUSIONS

The clinical and radiographic results indicated that operative treatment for hallux valgus with painful osteoarthritis of the lesser tarsometatarsal joint significantly improves forefoot and midfoot pain and function and has low complication rates.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Assessment of Changes in Hindfoot Alignment of Total Ankle Arthroplasty for Ankle Osteoarthritis on Weightbearing Subtalar X-ray View

Background

Recovering normal hindfoot alignment and correcting deformity of the ankle joint following total ankle arthroplasty (TAA) in osteoarthritis (OA) is essential for improving clinical outcomes and increasing long-term survival. We aim to evaluate hindfoot alignment following standard TAA compared to TAA with a total talar prosthesis ("combined TAA") in varus-type OA patients.

Methods

This retrospective study was conducted between 2010 and 2022. We included 27 patients (30 feet) who underwent standard TAA and 19 patients (22 feet) who underwent combined TAA. Hindfoot alignment at the subtalar joint was measured by weightbearing subtalar radiographic view before and after surgery.

Results

In the standard TAA, the angle between the tibial shaft axis and the articular surface of the talar dome joint (TTS) changed from 75 to 87 degrees (P < .01), the angle between the tibial axis and the surface on the middle facet (TMC) from 89 to 94 degrees (P < .01), and the angle between the tibial axis and the surface on the posterior facet (TPC) from 80 to 84 degrees (P < .01). The angle between the articular surface of the talar dome and the posterior facet of the calcaneus (SIA) decreased from 4.7 to -2.5 degrees (P < .01). In the combined TAA, TTS angle changed from 77 to 88 degrees (P < .01), TMC angle from 93 to 101 degrees (P < .01), TPC angle from 84 to 90 degrees (P < .05), and SIA from 6.6 to 2.1 degrees (P < .01). Varus deviation to the subtalar joint (TMC, TPC) significantly improved postoperatively in both groups. However, TPC was smaller than TTS and SIA was negative in standard TAA, and TPC was larger than TTS and SIA was positive in combined TAA.

Conclusion

The amount of correction of the subtalar joint differed depending on the ligament dissection of the subtalar joint and shape of the talar component.

Level of Evidence

Level III, retrospective cohort study.

Hindfoot Alignment and Ankle Stability Following Arthroscopic Lateral Ankle Ligament Repair

BACKGROUND

Hindfoot varus deformity is a known risk factor for chronic lateral ankle instability (CLAI). The impact of this deformity on clinical results following arthroscopic lateral ankle ligament repair (ALLR) for CLAI has not been studied.

METHODS

Sixty-three ankles from 62 patients who received ALLR for CLAI were retrospectively examined. Preoperative plain radiographs were used to measure tibial articular surface (TAS) angles, and long axial hindfoot alignment radiographs were used to measure tibiocalcaneal angles (TCAs) pre- and postoperatively. Results included ratings on the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and recurrent ankle instability (respraining of the operated ankle following surgery).

RESULTS

Recurrent ankle instability, defined as incidence of any new ankle sprain after surgery reported in the follow-up period, occurred in 13 ankles. The TAS angles of these patients were significantly low, and their preoperative TCA was significantly high. Multivariate analysis showed that preoperative TCA was an independent risk factor for recurrent ankle instability. The threshold values for preoperative TCA for recurrent instability were determined via the receiver operating characteristic curve analysis to be 3.4 degrees. Patients were assigned to a low- or high-TCA group based on the reported average TCA (2.7 degrees) of healthy patients. In the high-TCA group, recurrent instability was significantly more frequent, and the scores on the pain subscale of the postoperative SAFE-Q were significantly lower.

CONCLUSION

Hindfoot varus alignment was associated with pooreroutcomes after ALLR.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Stepwise decision making for CFL repair in addition to arthroscopic ATFL repair yields good clinical outcomes in chronic lateral ankle instability regardless of the remnant quality

BACKGROUND

Although arthroscopic anterior talofibular ligament (ATFL) repair for chronic lateral ankle instability (CLAI) has been widely performed, there are several issues such as the efficacy of the isolated ATFL repair for the ATFL and calcaneofibular ligament (CFL) injury and the influence of the poor remnant on the clinical outcomes to be discussed. This study aimed to evaluate clinical outcomes of the arthroscopic ATFL repair with the stepwise decision regarding the requirement of CFL repair and the influence of remnant qualities on clinical outcomes.

METHODS

Forty-four ankles underwent arthroscopic surgery to repair the lateral ankle ligament for CLAI. After arthroscopic ATFL repair, CFL repair was performed if instability remained. Clinical outcomes including the Karlsson-Peterson (KP) scores, Japanese Society for Surgery of the Foot (JSSF) scale, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were assessed at the final follow-up. ATFL remnants were classified into excellent, moderate, and poor according to the arthroscopic findings, and the clinical outcomes of each remnant group were compared.

RESULTS

Twenty-five ankles were required for CFL repair after ATFL repair. K-P score was significantly improved from 66.1 ± 5.3 to 94.8 ± 6.5 points (p < 0.01). JSSF scale was significantly improved from 70.5 ± 4.5 to 95.9 ± 6.0 points (p < 0.01). The SAFE-Q was also significantly improved on all subscales. There were no significant differences in clinical outcomes among excellent, moderate, and poor remnants.

CONCLUSIONS

Stepwise decision for CFL repair in addition to arthroscopic ATFL repair gave satisfactory clinical outcomes in CLAI regardless of the remnant quality.

Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair

BACKGROUND

Arthroscopic anterior talofibular ligament (ATFL) repair is widely performed for chronic lateral ankle instability (CLAI). Although many studies have reported excellent outcomes with this procedure, the recurrence of instability remains a common concern. Therefore, this study aimed to analyze the risk factors for the recurrence of instability after arthroscopic repair for CLAI.

METHODS

Fifty-six ankles of 53 patients with a mean age of 31.8 ± 14.7 years were retrospectively reviewed. All patients underwent arthroscopic ATFL repair. If instability remained immediately after ATFL repair, calcaneofibular ligament (CFL) repair was performed. The Ankle Activity Score (AAS) was assessed preoperatively, and clinical outcomes including the Japanese Society for Surgery of the Foot scale, Karlsson-Peterson scores, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated preoperatively and at the final follow-up. Talar tilt angle (TTA) was assessed preoperatively and 1 year postoperatively. Ankles were divided into 2 groups-nonrecurrence (postoperative TTA, <6 degrees) and recurrence (postoperative TTA, ≥6 degrees)-and clinical outcomes were compared.

RESULTS

Sixteen ankles showed recurrent instability, whereas 40 did not. AAS, TTA, and social functioning in the SAFE-Q were significantly higher in the recurrence group than those in the nonrecurrence group preoperatively. In addition, the rate of poor ATFL remnant quality and the number of CFLs not repaired despite the preoperative injury diagnosis were significantly higher in the recurrence group than in the nonrecurrence group.

CONCLUSION

Arthroscopic repair for ATFL and CFL deficiencies with preoperative high activity, poor remnant quality, and neglected CFL injury can result in the recurrence of instability. Appropriate surgical procedures to prevent the recurrence of instability should be selected for these ankles.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Impact of pain in other body regions on the foot-specific quality of life in patients with hallux valgus

OBJECTIVES

The purpose of this study was to clarify the prevalence of pain outside the foot, and to determine the associations of pain outside the foot with foot-specific quality of life (QOL) in patients with hallux valgus.

METHODS

Patients scheduled to undergo hallux valgus surgery were recruited. Patients answered whether they experienced disabling pain in 13 body regions other than the foot. Foot-specific QOLwas assessed using the Self-Administered Foot Evaluation questionnaire (SAFE-Q). Foot pain was quantified using the visual analogue scale (VAS). Patient characteristics, including age, sex, comorbidity, anxiety, and depression, were also surveyed. The association between pain elsewhere and the SAFE-Q and pain VAS scores were assessed using univariate and multivariate analyses.

RESULTS

Of 102 patients, 55 (54%) experienced pain other than the foot. All SAFE-Q subscale scores were lower, and pain VAS was higher in patients with pain elsewhere than in patients without. In the multivariate analysis, an increase in the number of pain regions was independently associated with a decrease in SAFE-Q scores and an increase in pain VAS.

CONCLUSION

More than half of the patients with hallux valgus experienced pain elsewhere. The presence of pain elsewhere was associated with poorer foot-specific QOL and severer foot pain.

Quality of life in Werner syndrome and associated subjective foot/ankle symptoms: A cross-sectional survey

AIM

The aims of this study were to assess the general quality of life and foot/ankle health-related quality of life among subjects with Werner syndrome (WS) and to determine subjective foot/ankle symptoms associated with quality of life.

METHODS

Using a questionnaire survey, patients were asked to provide information on age, sex and presence of subjective symptoms and complete both the 36-Item Short Form Health Survey (SF-36) questionnaire and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Statistical analyses were performed using Student's t-test, the Mann-Whitney U test, Fisher's exact test and Spearman's rank correlation.

RESULTS

Data from 12 patients with an average age of 54 ± 8.6 years were analyzed. The mean SF-36 score for the domain of physical functioning was 21.2; for role-physical function, 32.6; for bodily pain, 38.5; for general health, 34.4; for vitality, 44.8; for social function, 38.5; for role-emotional function and for mental health, 46.7. The mean mental component summary was as high as the national standard, but it was low in men. The mean SAFE-Q scores were also low. Patients with ulcers had significantly more pain and low general health perception. As compared with the national standard, the role/social component score was not low, and there was a correlation in most domains of the SAFE-Q.

CONCLUSION

In WS, the general health-related quality of life was low overall in the physical domain and low only in men for the mental domain, whereas it was low in the social domain when foot/ankle health-related quality of life was low. Geriatr Gerontol Int 2023; 23: 188-193.

Total Talar Replacement for Idiopathic Osteonecrosis of the Talus: Investigation of Clinical Outcomes, Pain, ADL, QOL

Background

Treatment of osteonecrosis of the talus is challenging. Nonoperative management includes nonweightbearing treatment. Various types of hindfoot fusion procedures have been performed, but delayed union and shortening of the operated leg have reportedly occurred. In contrast, talar body prosthesis is a surgical procedure with potential that relieves pain, restores ankle joint function, and is not associated with leg-length discrepancy. The aim of this study was to investigate postoperative pain, clinical outcomes, activities of daily living (ADL), and quality of life (QOL) after total talar replacement in patients with osteonecrosis of the talus.

Methods

Ten ankles in 10 patients with idiopathic osteonecrosis of the talus who were treated with a total talar replacement between 2007 and 2015 were included in the investigation. Scores according to the visual analog scale (VAS), Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, Functional Independence Measure (FIM), and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were assessed.

Results

The VAS score significantly improved from a mean of 80 ± 8 points before surgery to 18 ± 22 points after surgery (P < .01). The JSSF ankle-hindfoot scale score significantly improved from a mean of 53 ± 12 points before surgery to 89 ± 7 points after surgery (P < .01). The FIM score significantly improved from a mean of 122 ± 1 points before surgery to 125 ± 1 points after surgery (P < .01). The mean postoperative SAFE-Q scores were as follows: 81 ± 10.3 points for pain, 78 ± 14.7 points for physical function, 90 ± 12.4 points for social function, and 83 ± 15.4 points for shoe-related.

Conclusion

Total talar replacement is a useful treatment for patients with osteonecrosis of the talus. This replacement surgery preserves the function of the ankle and subtalar joints, and improves pain, ADL, and QOL.

Level of Evidence

Level IV, case series.

Anterior talofibular ligament remnant quality is important for achieving a stable ankle after arthroscopic lateral ankle ligament repair

PURPOSE

The relationship between ligament remnant quality and postoperative outcomes after arthroscopic lateral ankle ligament repair for chronic lateral ankle instability is controversial. This study aimed to determine whether the signal intensity of the anterior talofibular ligament on preoperative magnetic resonance imaging and ligament remnant quality identified on arthroscopy are associated with recurrent ankle instability after arthroscopic lateral ankle ligament repair.

METHODS

A total of 68 ankles from 67 patients with chronic lateral ankle instability who underwent arthroscopic lateral ankle ligament repair were retrospectively studied. The signal intensity of the anterior talofibular ligament was evaluated using T2-weighted magnetic resonance imaging. Arthroscopy was used to evaluate the thickness and mechanical resistance of the anterior talofibular ligament by hook palpation and to classify ankles into two groups: the present anterior talofibular ligament group with adequate mechanical resistance and the absent anterior talofibular ligament group with no mechanical resistance. The outcomes included recurrent ankle instability (respraining of the operated ankle after surgery) and Self-Administered Foot Evaluation Questionnaire scores.

RESULTS

Thirteen ankles were diagnosed with recurrent ankle instability. Patients with a high anterior talofibular ligament T2 signal intensity experienced more recurrent ankle instability than those with a low intensity. As determined via arthroscopy, the absent anterior talofibular ligament group had a higher rate of recurrent ankle instability than the present anterior talofibular ligament group. There were no significant differences in Self-Administered Foot Evaluation Questionnaire scores between patients with high and low anterior talofibular ligament T2 signal intensity, as well as between absent and present anterior talofibular ligament groups based on arthroscopy.

CONCLUSION

Poor quality of the anterior talofibular ligament remnant could result in recurrent ankle instability after arthroscopic lateral ankle ligament repair. Therefore, when treating chronic lateral ankle instability, surgeons should consider ligament quality.

LEVEL OF EVIDENCE

IV.

Bilateral and concomitant pathology' surgeries do not affect the outcomes of mini-open distal linear metatarsal osteotomy (Bosch osteotomy) with manipulation for hallux valgus deformity

BACKGROUND

Bosch osteotomy for hallux valgus (HV) deformity has advantages of reduction both the operating time and surgical dissection, and may be performed bilaterally and with fewer complications than other surgical procedures as well as early weight-bearing. However, there are few reports on the effects of bilateral simultaneous surgery, simultaneous surgery on concomitant pathologies, and the preoperative HV angle on the postoperative results. The present assessed the factors that might affect the improvement in clinical outcomes following mini-open Bosch osteotomy with manipulation to treat HV deformity.

METHODS

Seventy patients with 110 feet were included. They were divided into groups as follows: unilateral and bilateral simultaneous surgery groups, Bosch osteotomy alone and simultaneous surgeries for concomitant pathologies groups, and preoperative HV angle< 40° and ≥ 40° groups. Subjective clinical outcome scores using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and the HV and intermetatarsal first and second metatarsal (M1M2) angles according to the anteroposterior (A-P) view of the weighted foot X-ray were assessed preoperatively and at 12 months after surgery.

RESULTS

The mean HV angle, M1M2 angle and all subscales of the SAFE-Q score showed significant improvement at 12 months after surgery, regardless of simultaneous bilateral surgery, simultaneous surgery for concomitant pathologies, or the preoperative HV angle. On comparing the groups, there were no significant differences in the HV angle at 12 months after surgery. Significant inferiority at 12 months after surgery was found in the intermetatarsal angle in the simultaneous surgery for concomitant pathologies group and in all subscales of the SAFE-Q score in the HV angle ≥ 40° group.

CONCLUSION

Mini-open Bosch osteotomy with manipulation for HV deformity demonstrated good results in both radiological assessments and subjective clinical scores at 12 months after surgery, even for simultaneous bilateral surgery, simultaneous concomitant pathologies' surgery, and severe HV deformity.

LEVEL OF EVIDENCE

Prognostic Level III, retrospective cohort study.

Outcome after resection arthroplasty or shortening oblique osteotomy of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal joint for severe rheumatoid forefoot deformities

PURPOSE

We investigated objective and patient-reported outcomes after resection arthroplasty or shortening oblique osteotomy (SOO) of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal (MTP) joint for severe rheumatoid forefoot deformities.

METHODS

17 feet from 14 women (mean age, 67.8 years) underwent resection arthroplasty of the lesser metatarsal heads (MTH resection group), while 13 feet from nine women and two men (mean age, 68.7 years) underwent SOO of the lesser metatarsals (MTH preservation group). Arthrodesis of the first MTP joint was performed in all cases. Mean follow-up in the MTH resection and preservation groups was 25.0 and 21.3 months, respectively. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q) scores.

RESULTS

Mean total JSSF scale significantly improved from 53.4 to 76.4 in the MTH resection group (p < .001) and from 50.1 to 74.2 in the MTH preservation group (p = .002). Pain and pain-related and shoe-related SAFE-Q subscale scores significantly improved after surgery in both groups. In the MTH resection group, recurrence of painful callosities and claw toe deformity was observed in four and three feet, respectively. In the MTH preservation group, one patient experienced recurrence of painful callosities and one underwent revision surgery for IP joint dislocation.

CONCLUSION

Resection arthroplasty or SOO of the lesser metatarsals combined with arthrodesis of the first MTP joint achieved significant improvement with respect to pain relief, deformity correction, and footwear comfort.

Validity and reliability of the Persian version of self-administered foot evaluation questionnaire (SAFE-Q) in people with foot orthopedic problems

INTRODUCTION

Foot problems are one of the main causes of seeing a doctor. According to the World Health Organization's definition of health, the healthcare system must consider patients' quality of life as an important entity. In this regard, many tools have been developed to evaluate patients' opinions about their health status. The purpose of the present study is to evaluate the validity and reliability of the Persian version of the Foot Self-Assessment Questionnaire (SAFE-Q) in patients with foot orthopedic problems.

METHOD

215 people aged 17-60 years with orthopedic foot problems were included in this cross-sectional study. The Spearman correlation coefficient of SAFE-Q questionnaires versus Foot Function Index (FFI) questionnaire was evaluated for the convergent validity. Forty-three people randomly completed SAFE-Q again one week later. Intraclass correlation coefficient (ICC) and Cronbach's alpha was calculated to evaluate the test-retest reliability and internal consistency of the SAFE-Q, respectively.

RESULTS

A strong relationship was found between the SAFE-Q total score and other scales with FFI questionnaire (r = 0.52 to 0.87). ICC test-retest reliability and Cronbach's alpha were 0.981 and 0.98 for SAFE-Q, respectively.

CONCLUSION

The results indicate that the Persian version of the SAFE-Q questionnaire has acceptable validity and reliability and can be used to assess the health status and quality of life of Persian speakers with orthopedic foot problems.

What is the best way for an inexperienced surgeon to learn total ankle arthroplasty?

BACKGROUND

Previous reports on the learning curve of total ankle arthroplasty (TAA) revealed that inexperienced surgeons should be more careful about operative indications and procedures during the learning curve period. Patients who underwent surgery with inexperienced surgeons may be associated with inferior clinical outcomes, such as frequent complications. This study aimed to evaluate the effect of the participation of experienced surgeons as assistants on the results of TAA performed by inexperienced surgeons.

METHODS

Surgeons whose experience in performing TAA included less than 15 ankles were defined as inexperienced surgeons; on the other hand, those whose experience included more than 20 ankles were defined experienced surgeons in this study. Thirteen ankles operated by inexperienced surgeons, with an experienced surgeon who participated as an assistant, were assigned to the inexperienced group. Fifteen ankles operated on by an experienced surgeon were assigned to the experienced group. TNK Ankle (Kyocera, Kyoto, Japan) was used for all experiments. The coronal and sagittal alignments and the size of the tibial component relative to the tibial shaft were measured. Preoperative and postoperative Japanese Society for Surgery of the Foot (JSSF) and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were used for clinical assessment.

RESULTS

There were two malleolar fractures during the operation in both groups, and there were no cases of revision surgery. There were no significant differences in the coronal and sagittal tibial component alignment and size between the groups. The JSSF and SAFE-Q improved. There were no significant differences between groups, except for the preoperative JSSF score.

CONCLUSIONS

During the learning curve period, careful surgical indications and surgeries are desired. However, we found that when experienced surgeons participated as assistants, favorable results could be expected even when inexperienced surgeons performed the surgery.

LEVEL OF EVIDENCE

Ⅲ.

Varus-Tilted Distal Tibial Plafond Is a Risk Factor for Recurrent Ankle Instability After Arthroscopic Lateral Ankle Ligament Repair

BACKGROUND

Although varus-tilted distal tibial deformity is an established risk factor for chronic lateral ankle instability (CLAI), no studies have reported whether this deformity influences ankle instability after arthroscopic lateral ankle ligament repair (ALLR) for CLAI.

METHODS

A total of 57 ankles from 57 patients who underwent ALLR for CLAI were retrospectively analyzed. Tibial articular surface (TAS) angles were measured on preoperative plain radiograph. After 12 months of follow-up, recurrent ankle instability and talar tilt angles on stress radiograph were evaluated as outcomes. Relationships between the TAS angle and these outcomes were assessed.

RESULTS

Recurrent ankle instability was observed in 10 ankles. The TAS angles of patients with recurrent instability were significantly lower (85.2 degrees vs 87.9 degrees). The receiver operating characteristic curve analysis revealed that the cutoff value of TAS angle for recurrent instability was 86.2 degrees. Based on this cutoff value, our patients were divided into 2 groups: low-TAS and high-TAS group. Univariate and multivariate analysis revealed that low TAS was an independent risk factor for recurrent ankle instability and greater postoperative talar tilt angles.

CONCLUSION

Varus-tilted distal tibial plafond appears to be a risk factor for recurrent ankle instability after ALLR.

How does the postoperative medial arch height influence the patient reported outcomes of stage Ⅱ acquired adult flatfoot deformity?

BACKGROUND

This study aimed to assess how the postoperative medial arch height influenced postoperative patient-reported clinical outcomes after surgery for stage Ⅱ acquired adult flatfoot deformity.

METHODS

A total of 30 feet of 30 patients (7 males, 23 females) who underwent surgery for stage Ⅱ acquired adult flatfoot deformity and could be followed up for at least 2 years were included. The average age at surgery was 60.0 (standard deviation, 13.0) years, and the average follow-up period was 40 (standard deviation, 15.4) months. Among them, 16 patients underwent lateral column lengthening and 14 patients did not. Patient-reported clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire. Radiographic alignment was evaluated by the talonavicular coverage angle, lateral talo-1st metatarsal angle, medial cuneiform height, medial cuneiform to 5th metatarsal height, and calcaneal pitch. The correlation between postoperative Self-Administered Foot Evaluation Questionnaire and radiographic alignment was assessed with Pearson's correlation analysis.

RESULTS

Self-Administered Foot Evaluation Questionnaire and radiographic alignment significantly improved postoperatively in all patients (P < 0.0001). In patients with severe deformity who needed lateral column lengthening, lateral talo-1st metatarsal angle was negatively and medial cuneiform to 5th metatarsal height was positively correlated with physical functioning Self-Administered Foot Evaluation Questionnaire subscales (r = -0.56 and 0.55), and medial cuneiform height was positively correlated with physical functioning, social functioning and general health Self-Administered Foot Evaluation Questionnaire subscales (r = 0.70, 0.55 and 0.73, respectively).

CONCLUSION

Postoperative medial arch height could influence physical functioning, social functioning, and general health in patients with severe stage II adult-acquired flatfoot deformity.

Subjective and Objective Outcomes of Surgery for Rheumatoid Forefoot Deformities Under the Current Treatment Paradigm

We investigated the clinical outcomes of surgical procedures for the treatment of forefoot deformities in patients with rheumatoid arthritis. Twenty feet in 16 women (mean age 62.1 years) underwent corrective osteotomy of the first metatarsal bone with shortening oblique osteotomy of the lesser metatarsophalangeal joints (joint-preservation group), while 13 feet in 12 women (mean age 67.4 years) underwent arthrodesis of the first metatarsophalangeal joint with resection arthroplasty of the lesser metatarsophalangeal joints (joint-sacrifice group); mean follow-up for each group was 25.8 and 23.8 months, respectively. The mean total Japanese Society for Surgery of the Foot (JSSF) scale improved significantly from 64.2 to 89.2 in the joint-preservation group (p < .001), and from 54.2 to 74.2 in the joint-sacrifice group (p = .003). In the joint-preservation group, the postoperative range of motion (ROM) of the joint, walking ability, and activities of daily living scores of the JSSF scale were significantly higher than those in the joint-sacrifice group (p = .001, p = .001, and p = .019, respectively). There were no differences in the subscale scores of the self-administered foot evaluation questionnaire between 2 groups either pre- or postoperatively. No differences in the postoperative complications were found between 2 groups. Although the joint-sacrificing procedure resulted in lower objective outcomes than the joint-preserving procedure regarding the ROM of the joint, the walking ability, and the level of activities of daily living, both procedures resulted in similar treatment outcomes when evaluated by the subjective measures.

Effect of Foot Orthosis Treatment on Quality of Life in Secondary Sarcopenia Patients with Rheumatoid Arthritis-Related Foot Impairment

Objectives:

Patients with rheumatoid arthritis (RA)-related foot impairment have a high rate of sarcopenia. Treatment using a foot orthosis (FO) enables not only a reduction in pain while walking but also an increase in physical activity, helping to prevent further loss of muscle mass. However, the primary goal of treating RA is to maximize patients’ long-term quality of life (QOL). We investigated whether FO treatment both increases physical activity and improves QOL.

Methods:

Among 31 patients with RA-related foot impairment, 15 with sarcopenia were treated with an FO for 6 months. Foot-specific QOL (measuring using the Self-Administered Foot Evaluation Questionnaire), foot pain, activities of daily living, and physical activity (walking-intensity activity and moderate- to vigorous-intensity activity) were compared before treatment and after 6 months of treatment.

Results:

Ten patients who completed 6 months of follow-up were analyzed. Significant QOL improvements were found in the Pain and Pain-Related category and the Physical Functioning and Daily Living category (P = 0.02–0.04); however, no significant changes were found in the Social Functioning, General Health and Well-Being, or Shoe-Related categories (P = 0.09–0.21). Foot pain and activities of daily living significantly improved (P = 0.01–0.04). Physical activity significantly increased for walking-intensity activity (P = 0.04) but did not change for moderate- to vigorous-intensity activity (P = 1.00).

Conclusions:

FO treatment in patients with RA-related foot impairment and sarcopenia increased light-intensity physical activity such as walking and improved physical QOL.

Reconstruction of the Lateral Collateral Ligament Using a Suture Tape Anchor for Iatrogenic Hallux Varus

Iatrogenic hallux varus is a difficult complication of hallux valgus surgery. Although tendon transfer combined with bony correction is performed for hallux varus, tendon transfer has several disadvantages, such as the complicated nature of the procedure and the donor site morbidity. We describe the case of a 70-year-old woman with iatrogenic hallux varus treated by lateral collateral ligament (LCL) reconstruction using a suture tape anchor with bony correction. Tarsometatarsal joint arthrodesis was performed to correct the narrow intermetatarsal angle (IMA), and the varus deformity of the great toe at the metatarsophalangeal joint was corrected by anatomical reconstruction of the LCL using the suture tape anchor. One year postoperatively, the Japanese Society for Surgery of the Foot Hallux Metatarsophalangeal-Interphalangeal Scale had improved from 37 to 90 points. Radiography confirmed that the hallux valgus angle had been corrected from -24° to 4° and the IMA from 0° to 8°. Reconstruction of the LCL using suture tape anchor is an easy procedure for iatrogenic hallux varus which can achieve good stabilization.

Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities

BACKGROUND

Few studies have reported results of minimally invasive chevron Akin osteotomy (MICA) for moderate to severe hallux valgus correction. This study aims to evaluate MICA for moderate to severe hallux valgus radiographically and clinically.

METHODS

Forty feet were prospectively reviewed. Twenty-eight feet (70%) had a severe deformity (hallux valgus angle (HVA) ≥40° and/or first intermetatarsal angle (IMA) ≥18°). We measured HVA, IMA, lateral shape of the metatarsal head (round sign), tibial sesamoid position, first metatarsal shortening on anteroposterior weightbearing radiographs, and inclination angle of first metatarsal on lateral weightbearing radiographs. We evaluated the Japanese Society for Surgery of the Foot hallux scale and Self-Administered Foot Evaluation Questionnaire responses preoperatively and at the most recent follow-up.

RESULTS

All measurements except shortening and inclination angle improved significantly. Both clinical scale and all subscores significantly improved.

CONCLUSIONS

MICA improved moderate to severe hallux valgus both radiographically and clinically.Level of Evidence: Level IV: case series.

Arthroscopic ankle lateral ligament repair alone versus arthroscopic ankle lateral ligament repair with reinforcement by inferior extensor retinaculum

PURPOSE

This study aimed to compare the clinical outcomes and postoperative activities of arthroscopic ankle lateral ligament (ALL) repair alone with arthroscopic ALL repair and reinforcement by the inferior extensor retinaculum (IER) for chronic ankle instability (CAI).

MATERIALS AND METHODS

All patients who underwent arthroscopic repair for CAI between 2017 and 2019 were evaluated. The Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q), and duration between the surgery and walking without any support, jogging, and complete return to sports were evaluated and compared. The exclusion criteria were (1) follow-up period of < 1 year after surgery, (2) the presence of associated ankle lesions requiring treatment during the same operative procedure, including patients with subfibular ossicle bigger than 5 mm on radiographs, chondral or osteochondral defect, bony impingement, deltoid ligament tear, fibular tendon pathology, or posterior ankle impingement, and (3) patients who underwent revision surgery.

RESULTS

We identified 126 patients who underwent surgery for CAI and subsequently excluded 36 patients on account of a short follow-up period (< 1 year), additional surgery, and previous surgery. The remaining 90 eligible patients included arthroscopic ALL repair alone (group A, n = 44) and arthroscopic ALL repair with reinforcement by the inferior extensor retinaculum (group G, n = 46) groups. There was no significant difference in the postoperative activities nor in the preoperative or postoperative JSSF scale and SAFE-Q between the two groups. However, significant differences were seen in the mean surgical time (15.5 ± 8.1 vs 20.1 ± 7.6, P = 0.013).

CONCLUSION

This study showed no difference in clinical outcomes between the two groups. However, arthroscopic ALL repair with reinforcement by IER resulted in a longer surgical time than arthroscopic ALL repair alone.

LEVEL OF EVIDENCE

Retrospective comparative study, level III.

Clinical outcomes of concurrent surgery with weight bearing after modified lasso-loop stitch arthroscopic ankle stabilization

PURPOSE

To determine the effects of unilateral and bilateral ankle stabilization surgery with or without additional concurrent procedures for other pathologies on return to activity in patients who were allowed unrestricted weight bearing postoperatively.

METHODS

Ninety-three athletes underwent 120 ankle stabilization surgeries including 27 that underwent bilateral simultaneous surgery using the all-inside arthroscopy-modified lasso-loop technique and were divided into two groups: arthroscopic ligament repair alone without concurrent procedures (group A) and with simultaneous procedures for other pathologies (group B). Group A was further subdivided into unilateral (group A1) and simultaneous bilateral ankle surgery (group A2), and group B into ankle stabilization surgery with simultaneous procedures not requiring weight bearing postoperatively (Group B1) and with concurrent procedures allowing weight bearing (Group B2). Return to activity postoperatively was assessed by recording the time to walk without any support, jog, and return to full athletic activities. Clinical outcomes were assessed preoperatively and 12 months postoperatively using a subjective clinical score.

RESULTS

The average time between surgery and unsupported walk, jog, and return to full athletic activities was 1.6 ± 2.5, 16.9 ± 3.7, and 42.4 ± 19.3 days in group A, 17.2 ± 19.6, 34.5 ± 20.8, and 60.9 ± 22.8 days in group B, 1.7 ± 2.9, 16.1 ± 2.4, and 41.6 ± 18.2 days in group A1, 1.3 ± 0.6, 18.9 ± 5.5, and 44.6 ± 22.5 days in group A2, 25.3 ± 20.2, 43.3 ± 21.1, and 70.7 ± 23.1 days in group B1, and 4.8 ± 11.7, 20.7 ± 11.7, and 45.0 ± 13.7 days in group B2, respectively. These results indicate that the patients in group B2 showed a statistically significant faster time to return to activity than did those restricted from weight bearing. Differences in ankle stabilization alone between patients in groups A1 and A2 as well as groups B2 and A were not statistically significant. Clinical outcomes were similar for patients in groups B2 and A1 versus group A2.

CONCLUSION

Time to return to activity and clinical outcomes after ankle stabilization surgery using the modified lasso-loop technique were negatively affected if simultaneous bilateral surgery or simultaneous concurrent procedures were added or if weight bearing was unrestricted. However, a delay in return to athletic activity was observed when ankle stabilization surgery was performed using the modified lasso-loop technique with concurrent procedures that require non-weight bearing postoperatively.

LEVEL OF EVIDENCE

Level III.

Lateral Heel Pain Caused by Impingement of Hypertrophic Peroneal Tubercle and Os Peroneum

Hypertrophic peroneal tubercle (HPT) is an overgrowth of the peroneal tubercle located on the lateral aspect of the hindfoot, which could cause tenosynovitis of the peroneus longus tendon. Os peroneum (OP) is an accessory ossicle that exists in the peroneus longus tendon at the lateral aspect of the calcaneocuboid joint. Both HPT and OP can cause lateral foot pain and occasionally require surgical treatment. We encountered a case of lateral foot pain of HPT coexisting with OP. Careful preoperative magnetic resonance imaging, dynamic ultrasonographic image, and block injection suggested an impingement of HPT and OP as a cause of lateral foot pain. Surgical resection of HPT, while retaining OP, successfully achieved pain relief in the patient. To the best of our knowledge, this is the first report presenting a case of HPT coexisting with OP successfully treated without OP resection.

Nonunion of a medial malleolar stress fracture in an adolescent athlete secondary to lateral ankle instability: A case report

•

A 13-year-old male football player presented with chronic medial left ankle pain.

•

Radiographic examination showed nonunion of the medial malleolar stress fracture and chronic lateral ankle instability.

•

Internal fixation with the arthroscopic modified Broström procedure was performed.

•

The Self-Administered Foot Evaluation Questionnaire improved in all parameters.

•

The method is useful for medial malleolar stress fractures due to chronic lateral ankle instability.

Introduction

Medial malleolar stress fractures are relatively uncommon. This report describes the successful treatment of nonunion of a medial malleolar stress fracture due to chronic lateral ankle instability.

Presentation of case

A 13-year-old middle school student who belonged to a football club presented to our clinic with chronic medial left ankle pain lasting over a year. He had sprained his left ankle several times 6 years earlier. A plain anteroposterior ankle radiograph showed a vertical fracture line in the medial malleolus involving the epiphyseal plate, and computed tomography demonstrated the vertical fracture seen on the plain radiographs and bone sclerosis at the fracture site. We performed internal fixation for nonunion of the medial malleolar stress fracture with arthroscopic modified Broström for lateral ankle instability. Two years after surgery, the Self-Administered Foot Evaluation Questionnaire improved in all parameters, and both the anterior drawer and varus stress tests were negative.

Discussion

Early diagnosis of medial malleolar stress fracture is important for a rapid return to sports. Magnetic resonance imaging is helpful for early diagnosis. Because lateral ankle instability can cause medial malleolar stress fracture, arthroscopic modified Broström procedure is meaningful for medial malleolar stress fracture with lateral ankle instability.

Conclusion

Internal fixation and the arthroscopic modified Broström procedure could achieve good clinical outcomes for medial malleolar stress fractures with lateral ankle instability.

The Effect of Hallux Valgus Surgery on Quality of Life

BACKGROUND

Health-related quality of life (QOL) is defined as a patient's subjective perception of his or her own health. Insufficient data exist on QOL of patients who undergo a hallux valgus (HV) operation. We used a 36-item short form survey (SF-36) to measure QOL of such patients. Our aim was to evaluate the effect of HV on QOL and to identify QOL determinants.

METHODS

Fifty patients who underwent surgery for HV between 2015 and 2017 were included in the study. The SF-36 questionnaire was applied to the patients before and after surgery. Patients' medical records were examined to identify possible factors affecting QOL such as age, gender, body mass index, duration of symptoms, or smoking.

RESULTS

The mean age of the patients was 55.6 ± 3.8 years, and 42 of the 50 patients were women. The mean duration of disease was 12 ± 3.7 years. The surgery improved QOL scores for general health, emotional well-being, role limitations due to personal or emotional problems, physical functioning and bodily pain. However, the changes in scores for vitality and social functioning were not statistically significant. Lower postoperative QOL scores for emotional well-being and bodily pain were significantly associated with age and duration of the symptoms. Compared to the mean QOL of healthy adult Turkish population, all scores in subdimensions were lower.

CONCLUSIONS

This study shows that HV in adults has a negative impact on general health, bodily pain, physical functioning, physical and emotional well-being rather than social well-being and vitality.

Effectiveness of hallux valgus surgery on patient quality of life: a systematic review and meta-analysis

Background and purpose - The quality of life (QoL) of patients with hallux valgus (HV) usually improves postoperatively. Evidence regarding the effect of HV surgery on different domains of patient QoL remains inconclusive. This systematic review and meta-analysis estimates the effect of HV surgery on patient QoL through distinguishing effects on physical domains (comprising physical function and body pain domains) using the EuroQol-5D, short form (SF) health survey-12, and SF-36 QoL scales and a visual analogue scale (VAS) score and mental and social domains using QoL scales.Patients and methods - MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2019 for studies on the effect of HV surgery on patient QoL. A standardized mean difference score was calculated for each specific QoL domain (mental, social, pain, physical, and VAS) using Cohen's d index. The pooled effect size (ES) was estimated using a random-effects model based on the DerSimonian and Laird method.Results - From 12 published studies selected, the estimated pooled ES for QoL was 1.01 (95% confidence interval [CI] 0.52-1.51; I² = 87%) for body pain and 0.43 (CI 0.31-0.55, I² = 35%) for physical function. Regarding the composite mental and social domains of QoL, the pooled ES estimates were 0.24 (CI 0.00-0.47, I² = 80%) and 0.42 (CI 0.21-0.63, I² = 6.4%), respectively. The pooled difference in means for the VAS score was -4.1 (CI -4.5 to -3.6, I² = 90%).Interpretation - Our data showed that HV surgery decreased patients' perceptions regarding pain. Furthermore, the data confirmed that HV surgery increased patients' QoL, particularly concerning physical and social domains.

Operative Treatment for Hallux Valgus With Moderate to Severe Metatarsus Adductus

BACKGROUND

Operative treatment is indicated for patients who have symptomatic hallux valgus (HV) with moderate to severe metatarsus adductus (MA). However, there is limited information available on the operative procedures and outcomes for the treatment of HV with MA. We aimed to investigate the average 10-year follow-up clinical and radiologic outcomes.

METHODS

Seventeen patients (21 feet, average age: 60.1 years) with symptomatic HV with moderate to severe MA were operatively treated. Mean postoperative follow-up duration was 114.4 (24-246) months. All feet had metatarsus adductus angle ≥20 degrees on dorsoplantar weight-bearing radiograph. The procedure included a proximal crescentic osteotomy of the first metatarsal and abduction osteotomy of the proximal third of the second and third metatarsals.

RESULTS

The mean American Orthopaedic Foot & Ankle Society scale score improved significantly postoperatively ( P < .001). The mean postoperative visual analog scale score (17 feet) was 2.0 (0-6). Preoperative metatarsalgia was severe in 2 feet, moderate in 17, and mild in 2. At the most recent follow-up evaluation, 11 feet had no pain, 9 had mild pain, and 1 had moderate pain. The mean hallux valgus angle, intermetatarsal angle, and metatarsus adductus angle significantly decreased postoperatively ( P < .001 for all). Recurrence of HV (HV angle ≥ 20 degrees) was observed in 4 feet.

CONCLUSION

The clinical and radiologic results indicated that our novel operative treatment for HV with moderate to severe MA can achieve significant correction of HV with MA deformities and significant improvement in pain and function.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Total ankle arthroplasty incorporating a total talar prosthesis

Aims

Total ankle arthroplasty (TAA) has become the most reliable surgical solution for patients with end-stage arthritis of the ankle. Aseptic loosening of the talar component is the most common complication. A custom-made artificial talus can be used as the talar component in a combined TAA for patients with poor bone stock of the talus. The purpose of this study was to investigate the functional and clinical outcomes of combined TAA.

Patients and Methods

Ten patients (two men, eight women; ten ankles) treated using a combined TAA between 2009 and 2013 were matched for age, gender, and length of follow-up with 12 patients (one man, 11 women; 12 ankles) who underwent a standard TAA. All had end-stage arthritis of the ankle. The combined TAA features a tibial component of the TNK ankle (Kyocera, Kyoto, Japan) and an alumina ceramic artificial talus (Kyocera), designed using individualized CT data. The mean age at the time of surgery in the combined TAA and standard TAA groups was 71 years (61 to 82) and 75 years (62 to 82), respectively. The mean follow-up was 58 months (43 to 81) and 64 months (48 to 88), respectively. The outcome was assessed using the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, the Ankle Osteoarthritis Scale (AOS), and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q).

Results

The mean preoperative JSSF score of the combined TAA and standard TAA groups was 44 (sd 11) and 49 (sd 10), respectively. The mean postoperative JSSF scores were 89 (sd 6.1) and 72 (sd 15), respectively. The mean postoperative JSSF score of the combined TAA group was significantly higher (p = 0.0034). The mean preoperative AOS scores for pain and function in the combined TAA and standard TAA groups were 5.8 (sd 3.3) and 5.5 (sd 3.1), and 8.6 (sd 1.3), and 7.1 (sd 2.9), respectively. The mean postoperative AOS scores of pain and function were 2.5 (sd 2.5) and 2.2 (sd 1.9), and 2.5 (sd 3.3) and 3.4 (sd 2.9), respectively. There were no significant differences between the two groups in terms of postoperative AOS scores. The mean postoperative SAFE-Q scores were: for pain, 76 (sd 23) and 70 (sd 23); for physical function, 66 (sd 25) and 55 (sd 27); for social function, 73 (sd 35) and 62 (sd 34); for shoe-related, 73 (sd 19) and 65 (sd 26); and for general health, 78 (sd 28) and 67 (sd 29), respectively. There were no significant differences between the two groups in terms of postoperative SAFE-Q scores.

Conclusion

Combined TAA resulted in better clinical results than standard TAA. Cite this article: Bone Joint J 2019;101-B:443–446.

Distal Linear Metatarsal Osteotomy Combined with Akin Osteotomy for Hallux Valgus with Hallux Valgus Interphalangeus

Background:

Minimally invasive distal linear metatarsal osteotomy is commonly performed to correct mild-to-moderate hallux valgus. The technique is easy to perform, fast, and has a low complication rate with satisfactory clinical results. However, it has so far not been applied to hallux valgus with concomitant hallux valgus interphalangeus deformity.

Objective:

We aimed to investigate the short-term clinical results of distal linear metatarsal osteotomy combined with Akin osteotomy in hallux valgus with concomitant hallux valgus interphalangeus deformity.

Methods:

We retrospectively reviewed 10 patients (10 feet) who underwent surgery for hallux valgus with hallux valgus interphalangeus between 2012 and 2016. Akin osteotomy was performed and fixated with a screw/K-wire, followed by distal linear metatarsal osteotomy and K-wire fixation. Clinical evaluations pre- and postoperatively used the Japan Society for Surgery of the Foot (JSSF) scale and the Visual Analog Scale (VAS). Radiography pre-and postoperatively assessed the hallux valgus, hallux valgus interphalangeus, and the intermetatarsal angle.

Results:

The mean follow-up period was 20.2 months. Both the JSSF and VAS score improved significantly, from 64.5 to 90.0 and from 5.5 to 1.1, respectively. In all patients, bone healing was complete within four months with no osteonecrosis of the metatarsal head or malunion at the osteotomy site. The hallux valgus angle improved from 31.5° to 7.7°, the hallux valgus interphalangeus angle from 17.2° to 5.8°, and the intermetatarsal angle from 11.7° to 5.5°.

Conclusion:

Distal linear metatarsal osteotomy combined with Akin osteotomy safely and effectively corrects mild-to-moderate hallux valgus with hallux valgus interphalangeus deformity.