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Kim SJ, Gil YW, Sung IH. Preoperative patient's expectations and clinical outcomes after rheumatoid forefoot deformity reconstruction by joint sacrificing surgery. JOURNAL OF RHEUMATIC DISEASES 2024; 31:33-40. [PMID: 38130962 PMCID: PMC10730808 DOI: 10.4078/jrd.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
Objective To study the clinical and radiologic factors related with overall patient satisfaction of joint scarifying reconstruction on severe rheumatoid forefoot deformity (RFD). Methods Forty cases of RFD were retrospectively enrolled. A questionnaire on the factors for patient's expectations and satisfactions of the greater and lesser toes was administered, including repression of relapse in deformity (D), pain reduction (P), improvement in shoe wearing (S), barefoot activity (B), and appearance (A). Overall satisfaction were assessed using the 5-digit-scale. Hallux valgus angle, 1, 2 intermetatarsal angle, and other radiologic parameters were measured. Pearson's correlation and multiple linear regression analyses were used to evaluate the relationships between these factors and overall satisfaction. Results Overall satisfaction was 4.0±0.82. Postoperative radiologic parameters were corrected in adequate range. Visual analog scale (VAS) was reduced from 7.2±2.1 to 2.2±1.8. For the greater toe, patient's expectations (D, P, S, B, and A) were 4.2, 4.1, 3.0, 2.5, 2.7 and satisfactions were 4.2, 4.0, 3.4, 3.5, 3.3, respectively. For the lesser toes, patient's expectations (D, P, S, B, and A) were 3.9, 4.1, 3.4, 3.0, 2.8, and satisfactions were 3.4, 4.0, 3.4, 3.6, 2.9, respectively. Satisfactions with P and B, and reduction amounts of VAS were significantly correlated with overall satisfaction. Conclusion Although forefoot reconstruction with a joint sacrificing procedure is non-physiological, it could be a good surgical option for severe RFD. Each patient's expectations and satisfactions with this procedure could vary. Thus, it seems important to inform patients preoperatively that expectation could be fulfilled well or less.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Young-Woon Gil
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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Lotan R, Shlomov B, Dotan A, Bermant A, Hershkovich O. Hallux Valgus Repair with Chevron Osteotomy Significantly Narrows Forefoot Width. J Clin Med 2023; 12:jcm12072607. [PMID: 37048690 PMCID: PMC10094931 DOI: 10.3390/jcm12072607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/01/2023] Open
Abstract
Background: Hallux valgus (HV) is a common adult foot deformity. There is uncertainty concerning the effect of HV surgery on foot width. We examined the effect of chevron first metatarsal osteotomy on forefoot width using calibrated pre and postoperative standing radiographs. Methods: A retrospective cohort of 50 patients underwent chevron osteotomy HV surgery. All had HVA > 30°, IMA > 11°, DMMA > 3°, >6-month follow-up, and calibrated pre and postoperative standing foot radiographs. Bony width (BW) and soft tissue width (STW) were used to measure the surgery’s effect on foot width. Measurements were made preoperatively and 3–6 months following surgery. Results: The study group included 42 women with an average age of 63.4 (±8.3) and a mean BMI of 28.7 (±4.9). Preoperative HVA and IMA were 31.7° (±6.8°) and 13.4° (±2.8°), respectively. Following surgery, HVA and IMA improved significantly, by 15.6° (±5.7°) and 8.7° (±2.3°), respectively. The preoperative average BW was 9.4 cm (±0.6), and the STW was 10.6 cm (±0.7). Following surgery, significant changes in BW and STW were measured, with a mean narrowing of 1.2 cm (±0.4) in BW (p < 0.001) and 0.95 cm (±0.5) in STW (p < 0.001). Paradoxically, an increase in age led to a lower correction of the IMA (p = 0.04, r = 0.57), but higher BW and STW reductions (p = 0.01, r = 0.35 and p = 0.008, r = 0.37, respectively). Conclusions: This study reinforced chevron osteotomy as a valid treatment option that significantly narrows forefoot width; it is thus expected to improve cosmetic outcomes, shoe selection options, and quality of life. This study also found that older age correlates with better forefoot narrowing following hallux valgus repair, possibly due to stiffer soft tissues.
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Klavas DM, Rosemberg DL, Bordignon G, Lin J, Lee S, Bohl DD. Radiographic Forefoot Width Following Minimally Invasive Chevron Akin Bunionectomy. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221148191. [PMID: 36755967 PMCID: PMC9900161 DOI: 10.1177/24730114221148191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Hallux valgus (HV) is a common cause of pain and deformity of the forefoot. Minimally invasive chevron Akin (MICA) bunionectomy is a method for HV correction associated with less pain and swelling, with early return to weightbearing in a regular shoe. The purpose of this study was to determine how the MICA procedure affects forefoot width. Methods Twenty-eight patients (26 female, 2 male; 9 left, 19 right) at a single institution who underwent primary MICA for HV correction by 3 treating surgeons were retrospectively reviewed. Pre- and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), bony forefoot width, and soft tissue forefoot width were measured by 2 independent observers. Radiographic measurements were calibrated using fifth metatarsal length. Wilcoxon signed rank test compared changes in HVA, IMA, DMAA, and forefoot widths. Pearson correlation coefficient evaluated association between HVA, IMA, DMAA, and changes in forefoot width. Results At mean follow-up of 5.4 (range 3-13.7) months, bony forefoot width decreased significantly by 3.7 mm (4%, P < .001) and soft tissue forefoot width decreased by 2.5 mm (2%, P < .01). Decrease in HVA was moderately correlated with change in bony forefoot width (r = .38, P < .05) and change in soft tissue forefoot width (r = .45, P < .05). Decrease in IMA was moderately correlated with change in bony forefoot width (r = .45, P < .05) and change in soft tissue forefoot width (r = .44, P < .05). Conclusion The MICA procedure resulted in modest, yet significant, decrease in both bony and soft tissue forefoot width. Decrease in HVA and IMA demonstrated moderate correlation with changes in forefoot width. Patients can be counseled on these changes leading up to, and after, MICA bunionectomy surgery. Level of Evidence Level III, retrospective comparative series.
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Affiliation(s)
- Derek M. Klavas
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA,Derek M. Klavas, MD, Department of
Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St,
Chicago, IL 60612, USA.
| | - Dov L. Rosemberg
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA,International Research Fellow of
Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, RJ, Brazil,International Scholar at the Midwest
Orthopedics at Rush (MOR), Chicago, IL, USA,RUSH-IBTS International Fellowship
Program, Chicago, IL, USA,Lab. Prof. Manlio Mario Marco Napoli,
Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Glaucia Bordignon
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA,International Research Fellow of
Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, RJ, Brazil,International Scholar at the Midwest
Orthopedics at Rush (MOR), Chicago, IL, USA,RUSH-IBTS International Fellowship
Program, Chicago, IL, USA,Hospital Municipal Universitário de
Taubaté, Taubaté, SP, Brazil
| | - Johnny Lin
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | - Daniel D. Bohl
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA
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Albright R, Klein E, Baker J, Sorensen M, Weil L, Fleischer A. Are Radiographs Associated With Patient Satisfaction After Scarf Bunionectomy? J Foot Ankle Surg 2022; 62:2-6. [PMID: 35705454 DOI: 10.1053/j.jfas.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 02/03/2023]
Abstract
There are over 350,000 bunion surgeries performed in the USA annually, making it one of the most common elective forefoot surgeries. Studies have suggested that as many as 10% of patients remain dissatisfied after bunion surgery. The purpose of this study is to evaluate if radiographic variables are associated with patient satisfaction at 1 year postoperatively. We performed a secondary analysis of prospectively collected data on 69 consecutive adult patients (mean age 45 ± 14 years, 91% female [63/69]) who underwent isolated hallux valgus surgery from January 2016 to January 2017. Subjects completed a standardized 4-item survey inquiring about their satisfaction with regards to pain relief, overall operative result, cosmetic appearance, and ability to wear desired shoe gear. Conventional radiographic indices for hallux valgus were examined preoperatively and 3 months postoperatively. An association model using backward stepwise logistic regression was utilized to determine which variables, if any, are most important in explaining patient satisfaction after surgery. Sixty-nine subjects completed the 4-item satisfaction survey with 53.6% (37/69) of subjects answering they were fully satisfied on all aspects of the survey at 12 months postoperatively. In the final regression model, no radiographic or demographic variables were associated with patient satisfaction including shoe gear, cosmetic appearance, pain relief, and overall operative result. Radiographic variables did not appear to be associated with patient satisfaction at one year postoperatively in our study. Factors such as quality of life, anxiety levels, fear of surgery, and/or preoperative expectations may offer more insight into satisfaction; however, further research should be performed to examine this further.
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Affiliation(s)
- Rachel Albright
- Podiatrist, Department of Surgery, Stamford Health Medical Group, Stamford, CT.
| | - Erin Klein
- Associate Director of Research, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Jeffrey Baker
- Partner, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Matthew Sorensen
- Fellowship Director, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Lowell Weil
- CEO, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Adam Fleischer
- Director of Research, Weil Foot & Ankle Institute, Mount Prospect, IL; Professor, Rosalind Franklin University of Medicine and Science, North Chicago, IL
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Blouin C, Genet F, Denormandie P, Graff W, Perrier A. Development of a preoperative questionnaire to improve satisfaction with hallux valgus repair: A Delphi study. PLoS One 2022; 17:e0276303. [PMID: 36279269 PMCID: PMC9591061 DOI: 10.1371/journal.pone.0276303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Satisfaction with hallux valgus repair is often poor, despite good surgical outcomes. Many tools have been developed to assess the outcome of the procedure; however none evaluate the association between the initial motive for repair and the reasons for post-surgical dissatisfaction. The aim of this study was to develop a new tool to analyse the subjective and objective expectations of individuals during a pre-operative consultation for hallux valgus repair in order to improve post-surgical satisfaction. METHODS We first collected the reasons for dissatisfaction with repair from the medical files of dissatisfied individuals. Then, a steering committee of 4 French experts in the management of hallux valgus designed a questionnaire based on the reasons for dissatisfaction. We then used the DELPHI method to validate the questionnaire: we submitted the questionnaire to a panel of 34 francophone experts in hallux valgus repair for rating in 4 rounds. RESULTS The medical files of 853 individuals were reviewed and a 52-item questionnaire relating to expectations from hallux valgus surgery was drafted. After the 4 rounds, a final 44 item questionnaire reached consensus. Thirteen items related to clinical and psychological profile, 5 to pain, 9 to physical activity, 4 to aesthetics and 13 to footwear. CONCLUSION This tool should facilitate gathering of individuals' expectations from hallux valgus repair to ensure realistic goals and reduce post-surgical dissatisfaction.
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Affiliation(s)
- Cédric Blouin
- UFR Simone Veil-Santé, UR2020 Erphan, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- ISPC Synergies, Paris, France
- * E-mail:
| | - François Genet
- ISPC Synergies, Paris, France
- Département PARASPORT-SANTE, Unité Péri Opératoire du Handicap, (UPOH-Perioperative Disability Unit), Service de Médecine Physique et de Réadaptation, Hôpital Raymond-Poincaré, Groupe Hospitalo-Universitaire APHP-Université PARIS SACLAY, Garches, France
- UFR Simone Veil-Santé, END: ICAP, Inserm U1179, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
| | - Philippe Denormandie
- Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, APHP, Garches, France
- Groupe Mutuelle Nationale des Hospitaliers (MNH), Paris, France
| | - Wilfrid Graff
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
| | - Antoine Perrier
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- Laboratoire de Recherche Translationnelle et D’Innovation en Médecine et Complexité TIMC, CNRS, Grenoble, France
- Service de Diabétologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Hernández-Castillejo LE, Martínez-Vizcaíno V, Álvarez-Bueno C, Quijada-Rodríguez JL, Alonso-Galán M, Garrido-Miguel M. Effectiveness of hallux valgus surgery on improving health-related quality of life: A follow up study. Foot Ankle Surg 2022; 28:431-437. [PMID: 34454834 DOI: 10.1016/j.fas.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus (HV) negatively impacts health-related quality of life (HRQoL). Patientreported outcome measures (PROMs) are increasingly used in clinical studies of the foot and ankle. We aimed to evaluate the effect of HV surgery on PROMs (i.e., pain scales, general HRQoL, and region-specific scales) and radiological angles. Additionally, we aimed to determine whether the effect on these outcomes depends on the type of surgery (including open and percutaneous techniques) and if it is influenced by potential confounding factors (i.e., age, HVA, 1-2 IMA, body mass index (BMI), and distal metatarsal articular angle (DMAA). METHODS This was a longitudinal prospective study. We collected the clinical data of all patients who underwent surgery for symptomatic HV deformity in the orthopedic department of the Virgen de la Luz Hospital of Cuenca (Spain).The clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Hallux metatarsophalangeal-interphalangeal (HMI) scale, visual analogue scale (VAS), Manchester Oxford foot questionnaire (MOXFQ), short form health survey (SF-12) and European Quality of Life-5 Dimensions (EQ-5D). RESULTS A total of 72 patients (70 women, 97.2%) were included in the study 72 (72 feet).The AOFAS pre-post-surgery score changed from 42.16 (SD: 10.11) to 83.31 (SD: 6.23). Considering AOFAS domains, the pre-post change was from 14.17 (SD: 9.15) to 33.19 (SD: 4.69) for pain, from 27.22 (SD: 3.90) to 37.94 (SD: 2.78) for function, and from 0.78 (SD: 2.38) to 12.18 (SD: 3.45) for alignment. For other clinical outcomes was VAS score from 5.01(SD: 1.26) to 1.26 (SD: 0.96) and MOXFQ score from 61.44 (SD: 7.09) to 12.35 (SD: 4.85). SF-12 (physical) changed from 36.26 (SD: 5.32) to 47.06 (SD: 4.82), SF-12 (mental) from 38.23 (SD: 8.04) to 46.49 (SD: 4.16), and EQ5-D from 0.64 (SD: 0.008) to 0.90 (SD: 0.10). CONCLUSIONS Our data confirmed the improvements in the clinical and radiological outcomes after HV surgery, and provided some evidence of these improvements not depending on the type of surgery or on some potential confounding factors such as BMI, HVA, 1-2 IMA, and DMAA.
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Affiliation(s)
- Luis Enrique Hernández-Castillejo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Hospital Virgen de La Luz, Department of Orthopedic Surgery, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.
| | | | | | - Miriam Garrido-Miguel
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Faculty of Nursing, Universidad de Castilla-La Mancha, Albacete, Spain
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S/O K S RZE, Lee M, Chen J, Meng NYE. Do Patients Aged 70 Years and Older Benefit From Hallux Valgus Surgery? J Foot Ankle Surg 2022; 61:310-313. [PMID: 34535381 DOI: 10.1053/j.jfas.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/05/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
The prevalence of hallux valgus increases with age. However, few studies have compared the effectiveness of surgical correction among different age groups. The authors present a retrospective evaluation of the influence of age on clinical outcomes. Patients who underwent corrective surgery for hallux valgus at an academic hospital were stratified into 2 age groups: ≥70 years old (Group 1) and <70 years old (Group 2). Following propensity score matching there were 106 patients: 53 patients in each group. Clinical outcomes, quality of life, and satisfaction questionnaires were collected preoperatively and at 6 months and 24 months postoperatively. There were no differences between both patient groups in preoperative biodata and clinical parameters. However, elderly patients had significantly poorer Physical Component Summary scores postoperatively at both 6 months (p = .001) and 24 months (p < .001), and significantly poorer American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal- Interphalangeal Scale at 24 months (p = .026). There was no difference between the 2 groups in patient satisfaction rates at 24 months postoperatively (70% vs 85%, p > .05). Elderly patients display significant improvements in their clinical scores 24 months postoperatively with no significant difference between satisfaction rates with their younger counterparts. Elderly patients can stand to benefit from hallux valgus surgery.
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Affiliation(s)
| | - Merrill Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Jerry Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore; Duke- NUS Medical School, Singapore
| | - Nicholas Yeo Eng Meng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore; Duke- NUS Medical School, Singapore
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8
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Dismore LL, van Wersch A, Critchley R, Murty A, Swainston K. A qualitative study to understand patients’ experiences of their post-operative outcomes following forefoot surgery. Br J Pain 2022; 16:317-325. [DOI: 10.1177/20494637211060278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Hallux valgus and hallux rigidus are two common forefoot conditions causing deformity, pain, functional limitations, disability and deteriorating health status resulting in the requirement for surgery. Even when surgery is performed by an experienced surgeon, there remains a potential for patients to experience dissatisfaction and unfavourable outcomes. Adverse results are moderated by psychosocial variables; however, there is a paucity of qualitative research providing insight into how patients perceive their outcomes and the factors affecting their recovery. Objective The study aimed to qualitatively explore patients’ experiences of their surgical outcomes following forefoot surgery and factors associated with their recovery. Semi-structured interviews with 15 patients who received surgery for hallux valgus and/or hallux rigidus were conducted. Results Thematic analysis generated five themes: physical limitations, the psychosocial impact of surgical recovery, regaining normality, patients’ expectations for physical recovery and an altered body-image. Physical and psychosocial factors were inter-related. Patients experiencing problematic outcomes were functionally limited, had low mood and were unable to return to a normal life post-surgery. The women reported weight related issues and were limited in their footwear and clothing choices, negatively impacting on their self-esteem. Conclusion A forefoot condition is multifaceted, with patients experiencing a range of physical and psychological factors that may influence their outcomes and recovery from surgery. Patients need to be supported holistically with the use of a biopsychosocial model. A multidisciplinary approach to care and treatment within the forefoot surgical pathway with the inclusion of allied health professionals will enable to better support patients to enhance their outcomes.
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Affiliation(s)
- Lorelle Louise Dismore
- Department of Innovation, Research and Development, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Anna van Wersch
- School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
| | - Rebecca Critchley
- Department of Innovation, Research and Development, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Trauma and Orthopaedics Department, Wansbeck General Hospital,Northumbria Healthcare NHS Foundation Trust, Ashington, UK
| | - Aradhyula Murty
- Department of Innovation, Research and Development, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Trauma and Orthopaedics Department, Wansbeck General Hospital,Northumbria Healthcare NHS Foundation Trust, Ashington, UK
| | - Katherine Swainston
- School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
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Abstract
BACKGROUND In this study, our aim was to determine the effect of cosmetic improvement on patient satisfaction and functional scores in hallux valgus (HV) surgery. METHODS Preoperative foot photographs of 105 patients who had undergone chevron osteotomy for HV between 2016 and 2018 were taken. The patients were divided into 2 groups. Twenty-four months after surgery, the preoperative foot photographs were shown to patients in group 1 (n = 52) but not to patients in group 2 (n = 53). The groups were then compared using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP), and the 36-Item Short Form Health Survey (SF-36) scores. Both groups were evaluated radiologically with preoperative and postoperative hallux valgus angles and intermetatarsal angles. RESULTS There was no difference between the 2 groups in terms of radiologic parameters either pre- or postoperatively, or AOFAS Hallux MTP-IP scores postoperatively. However, for group 1, the VAS was lower (0.4±0.8 vs 1.8±1.6, P = .003) and both the SF-36 physical functioning (88.3±18.1 vs 79.1±23.2, P = .017) and SF-36 mental health scores were higher (78.8±19 vs 69.2±16.3, P = .022). CONCLUSION Visualizing improvement in the cosmetic appearance of the foot appears associated with patients' perception of subjective pain and functional improvement. We recommend that preoperative foot photographs be taken and recorded. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Hakan Bahar
- Orthopaedics & Traumatology Department, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Kadir Ilker Yildiz
- Orthopaedics & Traumatology Department, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
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10
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Sawah A, Zemenova S, Haque R, Ridley D, Abboud RJ, Wang W, Harrold F. Forecasting Posttreatment Outcome of Hallux Valgus Surgery Patients. Foot Ankle Int 2021; 42:1144-1152. [PMID: 34041931 PMCID: PMC8446886 DOI: 10.1177/10711007211002498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite advancements in operative techniques and the extraordinary number of procedures described for correcting hallux valgus (HV), there is still uncertainty as to why some patients thrive postoperatively whereas others do not. This study aimed to investigate whether the postoperative outcome of HV surgery could be predicted from patient demographics or functional impairment at the time of referral. METHODS The prospectively collected data, from 92 patients, were analyzed to determine whether patient demographics significantly influenced outcome 52 weeks after surgery. Potential relationships between socioeconomic deprivation and the outcome, as well as between preoperative functional impairment and postoperative improvement, were examined. The Manchester Oxford Foot Questionnaire (MOXFQ) and Scottish Index of Multiple Deprivation (SIMD) were used in this evaluation. RESULTS None of the demographics studied were found to be statistically significant determinants of outcome. Preoperative MOXFQ scores for patients from the most deprived areas were significantly worse at the time of referral. Patients living in the least deprived postcodes experienced the lowest improvement in MOXFQ scores. Patients from the most deprived SIMD quintile achieved significantly higher improvement in MOXFQ-walking and standing compared to those from the least deprived quintile. A strong positive correlation was found between the preoperative MOXFQ scores and the improvement in the scores postoperatively. CONCLUSION In this patient cohort, demographics could not be used to predict the postoperative outcome at week 52. Socioeconomic disparities seem to influence the timing of patients seeking surgery. Lower preoperative MOXFQ scores strongly correlate with a lesser degree of postoperative improvement. LEVEL OF EVIDENCE Level III, retrospective study with prospective arm.
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Affiliation(s)
- Amjad Sawah
- University Department of Orthopaedic
& Trauma Surgery, Ninewells Hospital & Medical School, University of Dundee,
Dundee, Scotland, UK
- Orthopaedic and Trauma Department, Main
Klinik Ochsenfurt, Teaching Hospital of University of Wurzburg, Germany
- Amjad Sawah, MD, MCh Orth, University
Department of Orthopaedic & Trauma Surgery, Ninewells Hospital & Medical
School, University of Dundee, Dundee, Scotland DD1 9SY, UK.
| | | | - Russel Haque
- University Department of Orthopaedic
& Trauma Surgery, Ninewells Hospital & Medical School, University of Dundee,
Dundee, Scotland, UK
- Limb Reconstruction Centre, Macquarie
University Hospital, Sydney, Australia
| | - David Ridley
- University Department of Orthopaedic
& Trauma Surgery, Ninewells Hospital & Medical School, University of Dundee,
Dundee, Scotland, UK
| | - Rami J. Abboud
- University Department of Orthopaedic
& Trauma Surgery, Ninewells Hospital & Medical School, University of Dundee,
Dundee, Scotland, UK
- Dean’s Office, Faculty of Engineering,
University of Balamand, Qalhat, Lebanon
| | - Weijie Wang
- University Department of Orthopaedic
& Trauma Surgery, Ninewells Hospital & Medical School, University of Dundee,
Dundee, Scotland, UK
| | - Fraser Harrold
- University Department of Orthopaedic
& Trauma Surgery, Ninewells Hospital & Medical School, University of Dundee,
Dundee, Scotland, UK
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Sharma AK, Elbuluk AM, Gkiatas I, Kim JM, Sculco PK, Vigdorchik JM. Mental Health in Patients Undergoing Orthopaedic Surgery: Diagnosis, Management, and Outcomes. JBJS Rev 2021; 9:01874474-202107000-00013. [PMID: 34297704 DOI: 10.2106/jbjs.rvw.20.00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Mental health and psychosocial factors play a critical role in clinical outcomes in orthopaedic surgery. » The biopsychosocial model of disease defines health as a product of physiology, psychology, and social factors and, traditionally, has not been as emphasized in the care of musculoskeletal disease. » Improvement in postoperative outcomes and patient satisfaction is incumbent upon the screening, recognition, assessment, and possible referral of patients with high-risk psychosocial factors both before and after the surgical procedure.
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Affiliation(s)
- Abhinav K Sharma
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ameer M Elbuluk
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Julia M Kim
- Clinical Psychology, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Chrea B, Day J, Henry J, Cody E, Ellis S. Influence of Complications and Revision Surgery on Fulfillment of Expectations in Foot and Ankle Surgery. Foot Ankle Int 2021; 42:859-866. [PMID: 33525945 DOI: 10.1177/1071100720985231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fulfillment of patients' expectations following foot and ankle surgery has been previously studied, and shown to be an effective modality in assessing patient-reported outcomes (PROs). Although this assessment has been shown to correlate well with patient satisfaction and other validated PROs, the impact of postoperative complications on fulfillment of expectations is unknown. The aim of this study is to therefore investigate the impact of postoperative complications on fulfillment of patients' expectations. METHODS Preoperatively, patients completed a validated Foot and Ankle Expectations Survey consisting of 23 questions encompassing domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. Chart review was performed to identify patient demographics, comorbidities, pain management, and postoperative complications, which were classified as minor (infection requiring antibiotics) or major (return to operating room for revision, deep infection). FP in patients with a complication was compared to patients who did not experience a complication. In addition, the Foot and Ankle Outcomes Score (FAOS), satisfaction, and Delighted-Terrible scale (how they would feel if asked to spend the rest of their life with their current foot/ankle symptom) were collected at final follow-up. Of the 271 patients (mean age 55.4 years, 65% female), 31 (11.4%, mean age 53.6, 58% female) had a postoperative complication: 25 major (19 revisions, 6 deep infections requiring irrigation and debridement), 4 minor (4 superficial infections requiring antibiotics), and 2 major and minor (revision and superficial infection). Average time from complication to completion of fulfillment survey was 15 (±3.6) months. The groups were similar in diagnoses. RESULTS Complications were associated with significantly worse FP (0.69 ± 0.45 vs 0.86 ± 0.40, P = .02). Having a complication significantly correlated with worse satisfaction, Delighted-Terrible scale, and FP (P < .001). FAOS domains were similar between groups preoperatively; postoperatively, patients without complications had significantly higher Activities of Daily Living and Quality of Life scores (P < .05). Demographically, there was no difference in age, sex, body mass index, Charlson Comorbidity Index, depression/anxiety, or pain management between the 2 groups. CONCLUSION Our data suggests that postoperative complications following foot and ankle surgery were associated with worse patient-reported fulfillment of their operative expectations even after recovery from the initial surgery and complication. This finding is independent of preoperative expectations, and correlates with patient satisfaction with their procedure. Therefore, while patient-perceived fulfillment following foot and ankle surgery is multifactorial, the incidence of a postoperative complication negatively impacts fulfillment as well as satisfaction following surgery. LEVEL OF EVIDENCE Level II, prospective comparative series.
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Affiliation(s)
- Bopha Chrea
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | | | - Scott Ellis
- Hospital for Special Surgery, New York, NY, USA
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13
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Defining the patient acceptable symptom state for the American Orthopaedic Foot & Ankle Society score following hallux valgus surgery. Foot Ankle Surg 2021; 27:528-534. [PMID: 32653409 DOI: 10.1016/j.fas.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to define the patient acceptable symptom state (PASS) for the American Orthopaedic Foot & Ankle Society score (AOFAS) following hallux valgus surgery. METHODS 548 patients underwent hallux valgus surgery and had AOFAS assessed preoperatively, 6 months and 2 years postoperatively. Responses to an anchor question were used as external criterion in receiver operating characteristics (ROC) analyses to define PASS thresholds. RESULTS In total, 429 patients (78.3%) reported their current state as acceptable. Areas under the curve (AUC) for ROCs were 0.71-0.81 for all analyses. PASS threshold was 88.5 at 2 years (sensitivity 64%, specificity 85%). Sensitivity analyses revealed that the threshold was robust. CONCLUSIONS Patients with an AOFAS of 88.5 consider their postoperative symptom state to be acceptable. This knowledge will enable clinicians to identify patients who have attained a satisfactory functional status after hallux valgus surgery.
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Biz C, Crimì A, Fantoni I, Tagliapietra J, Ruggieri P. Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus. Foot Ankle Int 2021; 42:409-424. [PMID: 33319594 DOI: 10.1177/1071100720969676] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was aimed at assessing clinical and radiographic outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus (HV) and the long-term persistence of its effects. METHODS This case series study involved 100 patients, 84 women and 16 men (mean age, 59 years), who underwent the MIIND procedure with a mean follow-up of 97 months. Assessment was performed preoperatively, postoperatively, at 6 and 12 months, and at last follow-up. Clinical outcomes were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and tibial sesamoid position were assessed. Statistical analysis was performed. RESULTS The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 ± 2.0, and patients' satisfaction was 8.7 ± 1.4. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex (P = .047), severity (P = .050), associated procedures (P = .000), and preoperative angle (P = .000) showed significant association with HVA correction and its persistence over time. Age was not statistically significant. Complications were 9 cases of superficial wound infection and 6 recurrences. CONCLUSIONS The MIIND technique proved a viable procedure to correct moderate to severe HV with a low rate of complications and recurrence, producing significant correction of most radiographic parameters assessed and their persistence, even at long term. LEVEL OF EVIDENCE Level IV, case series study.
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Affiliation(s)
- Carlo Biz
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Alberto Crimì
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Ilaria Fantoni
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Jacopo Tagliapietra
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
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Hernández-Castillejo LE, Álvarez-Bueno C, Garrido-Miguel M, Torres-Costoso A, Reina-Gutiérrez S, Martínez-Vizcaíno V. The effect of hallux valgus open and percutaneous surgery on AOFAS scale: a systematic review and meta-analysis. Qual Life Res 2021; 30:957-966. [PMID: 33387287 DOI: 10.1007/s11136-020-02715-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To estimate the comparative effect of open and percutaneous hallux valgus (HV) surgery on patients' quality of life (QoL) using the American Orthopedic Foot and Ankle Society (AOFAS) scale including total score and individual domains (pain, function, and alignment). METHODS MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2020 for studies on the effect of HV surgery on patients' QoL using the AOFAS score. A standardized mean difference score was calculated on the total AOFAS score and on each AOFAS domain (pain, function, and alignment) using Cohen's d index. RESULTS Considering the 53 published studies included, the pooled effect size (ES) estimates for the AOFAS total score were 3.69 (95% CI 3.37-4.01; I2 = 95.5%) for open surgery and 3.40 (95% CI 2.99-3.80, I2 = 88.2%) for percutaneous surgery. The total pooled ES estimate was 3.61 (95% CI 3.35-3.87, I2 = 94.5%). Considering the pain domain, the pooled ES estimates were 2.21 (95% CI 1.98-2.43, I2 = 64%) for open surgery and 2.52 (95% CI 1.83-3.20, I2 = 92.6%) for percutaneous surgery. For the function domain, the pooled ES estimates were 1.37 (95% CI 0.93-1.81, I2 = 91%) for open surgery and 2.28 (95% CI 1.10-3.47, I2 = 96.8%) for percutaneous surgery. Finally, the pooled ES estimates for the alignment domain were 3.99 (95% CI 3.51-4.47, I2 = 85.7%) for open surgery and 2.66 (95% CI 2.23-3.09, I2 = 78.5%) for percutaneous surgery. CONCLUSION Our data support that HV surgery increases the total AOFAS score as well as the AOFAS scores by domain (pain, function, and alignment). Furthermore, our data show that HV surgery increases patients' QoL, after both open and percutaneous surgery, without differences between them.
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Affiliation(s)
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain. .,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.
| | | | - Ana Torres-Costoso
- School of Nursing and Physiotherapy, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Sara Reina-Gutiérrez
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain.,Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Talca, Chile
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Vaida J, Ray JJ, Shackleford TL, DeCarbo WT, Hatch DJ, Dayton P, McAleer JP, Smith WB, Santrock RD. Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420934804. [PMID: 35097396 PMCID: PMC8697068 DOI: 10.1177/2473011420934804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar first tarsometatarsal (TMT) arthrodesis could achieve this goal by 3-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar first TMT arthrodesis. METHODS After receiving Institutional Review Board approval, charts were retrospectively reviewed for patients undergoing triplanar first TMT arthrodesis for hallux valgus at 4 institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (eg, Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. One hundred forty-eight feet from 144 patients (48.1 ± 15.7 years, 92.5% female) met inclusion criteria. RESULTS Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperatively (P < .001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperatively (P < .001). Postoperatively, patients had an average 10.4 ± 4.0 mm reduction (10.8% reduction) in osseous width and average 7.3 ± 4.0 mm reduction (6.8% reduction) in soft tissue width. CONCLUSIONS Triplanar first TMT arthrodesis reduced both osseous and soft tissue foot width, providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width. Level of evidence: Level III, retrospective comparative study.
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Affiliation(s)
- Justin Vaida
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Justin J Ray
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | | | | | - Daniel J Hatch
- Foot and Ankle Center of Northern Colorado, Greeley, CO, USA
| | - Paul Dayton
- Foot & Ankle Center of Iowa, Midwest Bunion Center, Ankeny, IA, USA
| | - Jody P McAleer
- Jefferson City Medical Group, Department of Podiatry, Jefferson City, MO, USA
| | - W Bret Smith
- Mercy Orthopedic Associates, Mercy Regional Medical Center, Durango, CO, USA
| | - Robert D Santrock
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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Conti MS, MacMahon A, Ellis SJ, Cody EA. Effect of the Modified Lapidus Procedure for Hallux Valgus on Foot Width. Foot Ankle Int 2020; 41:154-159. [PMID: 31665921 DOI: 10.1177/1071100719884556] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the importance of shoe wear to patients with hallux valgus (HV), few studies have investigated changes in foot width following surgery in this population. The purpose of our study was to determine if the modified Lapidus procedure would effectively decrease foot width in patients with HV. METHODS Thirty-one feet (19 left, 12 right) in 30 patients (29 females, 1 male) who underwent a modified Lapidus procedure in combination with a modified McBride and Akin osteotomy for treatment of HV were included in the study. All patients had preoperative and at least 5-month postoperative imaging, consisting of both weightbearing radiographs and computed tomography (WBCT) scans, which were used to measure bony and soft tissue foot widths pre- and postoperatively by 2 independent observers. RESULTS Intraclass correlation coefficients (ICCs) demonstrated high interobserver reliability (all ICCs >0.90). Bony foot width decreased significantly, by a mean of 8.9 mm (9.1%) on radiographs and 7.9 mm (8.4%) on WBCT scans (P < .001). The soft tissue foot width also decreased significantly, by a mean of 6.9 mm (6.3%) on radiographs and 6.7 mm (6.4%) on WBCT scans (P < .001). Changes in the hallux valgus angle and intermetatarsal angle correlated with changes in bony foot width on WBCTs (both r > 0.4, P < .02). CONCLUSIONS The modified Lapidus procedure in combination with a modified McBride and Akin osteotomy resulted in statistically significant changes in both bony and soft tissue foot width. Patients should be counseled that foot width decreases, on average, by 0.5 to 1 cm. LEVEL OF EVIDENCE Level III, comparative series.
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Lim WSR, Liow MHL, Rikhraj IS, Goh GSH, Koo K. The effect of gender in hallux valgus surgery. A propensity score matched study. Foot Ankle Surg 2019; 25:670-673. [PMID: 30321927 DOI: 10.1016/j.fas.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Males and females who undergo hallux valgus (HV) surgery have different expectations. METHODS Data from 439 patients, with 26 males, were prospectively collected between 2007-2015. Propensity score matching (PSM) of one male to two females was performed using logistic regression of six variables to minimize selection bias. Hallux visual analogue scale (VAS) scores, AOFAS scores, SF-36, satisfaction and expectation scores were analysed at two years. RESULTS There were no significant differences in patient demographics after PSM. At two years, males and females attained similar VAS and AOFAS scores but males had significantly lower SF-36 general health score (males 68.7, females 79.3). 26.9% of males and 21.2% of females were not satisfied after surgery. Higher proportion of males did not have their expectations fulfilled (males 19.2%, females 5.8%) although this was not statistically significant. CONCLUSIONS Both genders attain similar outcome at two years. There is a trend towards lower expectation fulfilment in males after surgery.
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Affiliation(s)
- Winston Shang Rong Lim
- Singapore General Hospital, Department of Orthopaedic Surgery, 20 College Road, 169856, Singapore.
| | - Ming Han Lincoln Liow
- Singapore General Hospital, Department of Orthopaedic Surgery, 20 College Road, 169856, Singapore
| | - Inderjeet Singh Rikhraj
- Singapore General Hospital, Department of Orthopaedic Surgery, 20 College Road, 169856, Singapore
| | - Graham Seow-Hng Goh
- Singapore General Hospital, Department of Orthopaedic Surgery, 20 College Road, 169856, Singapore
| | - Kevin Koo
- Singapore General Hospital, Department of Orthopaedic Surgery, 20 College Road, 169856, Singapore
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Lai SWH, Tang CQY, Graetz AEK, Thevendran G. Preoperative Mental Health Score and Postoperative Outcome After Hallux Valgus Surgery. Foot Ankle Int 2018; 39:1403-1409. [PMID: 30175616 DOI: 10.1177/1071100718794661] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Preoperative mental health status as a predictor of operative outcome has been a growing area of interest. In this paper, the correlation between preoperative mental health status and postoperative functional outcome following scarf osteotomy for hallux valgus correction was explored. METHODS: Parameters were tabulated preoperatively and postoperatively at a minimum of 1-year follow-up. They included the Short Form 36 (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) measurements and the visual analog score (VAS) to quantify pain. SF-36 mental component summary (MCS) score was used as a surrogate for patient's mental health status. Seventy-six consecutive cases were analyzed at a minimum of 1-year follow-up. RESULTS: There were significant improvements in all 8 domains of the SF-36, with the mean MCS score increasing from 52.3 ± 7.6 preoperatively to 55.7 ± 6.8 postoperatively. Preoperative MCS scores were not correlated to changes in AOFAS score, PCS score, VAS pain score, HVA or IMA. Preoperative MCS was observed to be correlated to postoperative AOFAS ( r = 0.381, P = .001) and PCS score ( r = 0.315, P = .006). Patients with a preoperative MCS score ⩾50 had a statistically higher postoperative AOFAS and PCS score than patients with MCS score <50. There was no correlation between preoperative MCS scores and improvements in radiologic parameters. There was also no correlation between the improvements in radiologic parameters and improvements in both the AOFAS and VAS pain scores. CONCLUSION: Preoperative mental health (as measured by the MCS score) was only correlated to postoperative functional outcome (as measured by the postoperative AOFAS and PCS score), but not other postoperative outcomes (VAS pain score, radiologic parameters). LEVEL OF EVIDENCE: Level III, comparative study.
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Affiliation(s)
- Sean Wei Hong Lai
- 1 Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Tenenbaum SA, Herman A, Bruck N, Bariteau JT, Thein R, Coifman O. Foot Width Changes Following Hallux Valgus Surgery. Foot Ankle Int 2018; 39:1272-1277. [PMID: 29952666 DOI: 10.1177/1071100718783458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus (HV) adversely affects quality of life. Patients frequently express concerns regarding postoperative foot appearance, foot width and footwear anticipations. However, only scarce data are available regarding postoperative foot width. MATERIALS AND METHODS Seventy-one cases with moderate to severe HV treated with scarf osteotomy were included. The average age was 55.7 years (range, 20-76), with average follow-up of 20.7 months (range, 6-96). Patients' medical records were reviewed for demographic, operative, and radiographic data. Foot width was assessed radiographically by measuring both bone (distance between the first and fifth metatarsal heads) and soft tissue width (maximal distance of the soft tissue outline). RESULTS Preoperative HV deformity (mean hallux valgus angle [HVA] 35.8 degrees, intermetatarsal angle [IMA] 14.1 degrees, and distal metatarsal articular angle [DMAA] 15.2 degrees) was successfully corrected (postoperative mean HVA 13.7 degrees, IMA 6.9 degrees, and DMAA 7.7 degrees). Overall bony foot width was reduced by 5% and soft tissue foot width by 2%. Further analysis showed that 13 feet (18.3%) had increased (>5%) bone width, 26 feet (36.6%) with no change (±5%), and 32 feet (45.1%) for which the width decreased (>5%) postoperatively. Angular deformity (HVA, IMA, and DMAA) showed low correlation with postsurgery foot width. CONCLUSION HV surgery effect on foot width was very limited, overall reducing foot width by 2%. Furthermore, in only about half of the patients, the postoperative foot width decreased, regardless of angular deformity magnitude. Patients with the widest feet had a decrease in foot width following surgery, whereas patients with the narrowest feet had an increase in foot width. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Shay A Tenenbaum
- 1 Department of Orthopedic Surgery, Chaim Sheba medical center at Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Herman
- 2 Department of Orthopaedic Surgery, Assuta Ashdod, Ashdod, Israel; affiliated to Bear Sheva university, Bear Sheva, Israel
| | - Nathan Bruck
- 1 Department of Orthopedic Surgery, Chaim Sheba medical center at Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jason T Bariteau
- 3 Department of Orthopedics, Emory University School Medicine, Atlanta, GA, USA
| | - Ran Thein
- 1 Department of Orthopedic Surgery, Chaim Sheba medical center at Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Coifman
- 1 Department of Orthopedic Surgery, Chaim Sheba medical center at Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cody EA, Do HT, Koltsov JCB, Mancuso CA, Ellis SJ. Influence of Diagnosis and Other Factors on Patients' Expectations of Foot and Ankle Surgery. Foot Ankle Int 2018; 39:641-648. [PMID: 29448824 DOI: 10.1177/1071100718755473] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many patient factors have been associated with higher or lower expectations of orthopedic surgery. In foot and ankle surgery, the diverse diagnoses seen may also influence expectations. The aim of this study was to investigate the relationship between diagnosis and patients' preoperative expectations of elective foot and ankle surgery. METHODS Two hundred seventy-eight patients undergoing elective foot or ankle surgery for 1 of 7 common diagnoses were enrolled in a prospective cohort study. Preoperative expectations were assessed with the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey. Patients also completed the Foot & Ankle Outcome Score, Short Form 12, pain visual analog scale, and questionnaires for depressive and anxiety symptoms. Demographic and clinical data were collected. Patient factors and diagnosis were analyzed using multivariate regression analysis to identify independent predictors of higher expectations and determine the effect of diagnosis relative to other patient factors on expectations. RESULTS The multivariate regression analysis adjusting for demographics and other clinical characteristics showed that diagnosis contributed the most to the model, accounting for 10.5% of the variation in expectations survey scores. Patients with mid- or hindfoot arthritis ( P < .001), hallux valgus ( P = .001), or hallux rigidus ( P = .005) had lower scores (lower expectations) than those with ankle instability or osteochondral lesion. In the model, female sex ( P = .001), non-Caucasian race ( P = .031), and lower scores on the Foot & Ankle Outcome Score daily activities subscale ( P = .024) were associated with higher scores. CONCLUSIONS Diagnosis of ankle instability or osteochondral lesion, female sex, non-Caucasian race, and lower Foot & Ankle Outcome Score daily activities subscale score were all associated with higher expectations. These findings may help inform and guide surgeons as they counsel patients preoperatively. LEVEL OF EVIDENCE Level II, cross-sectional study.
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Affiliation(s)
| | - Huong T Do
- 2 Hospital for Special Surgery, New York, NY, USA
| | - Jayme C B Koltsov
- 3 Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Cody EA, Mancuso CA, Burket JC, Marinescu A, MacMahon A, Ellis SJ. Patient Factors Associated With Higher Expectations From Foot and Ankle Surgery. Foot Ankle Int 2017; 38:472-478. [PMID: 28196438 DOI: 10.1177/1071100717690807] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few authors have investigated patients' expectations from foot and ankle surgery. In this study, we aimed to examine relationships between patients' preoperative expectations and their demographic and clinical characteristics. We hypothesized that patients with more disability and those with anxiety or depressive symptoms would have greater expectations. METHODS All adult patients scheduled for elective foot or ankle surgery by 1 of 6 orthopaedic foot and ankle surgeons were screened for inclusion over 8 months. Preoperatively, all patients completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey in addition to the Foot & Ankle Outcome Score (FAOS), Short Form (SF)-12, Patient Health Questionnaire (PHQ)-8, Generalized Anxiety Disorder 7-item scale (GAD-7), and pain visual analog scale (VAS). The expectations survey contained 23 expectations categories, each with 5 answer choices ranging from "I do not have this expectation" to "complete improvement" expected. It was scored from 0 to 100, with higher scores indicating more expectations. Differences in expectations relating to numerous patient demographic and clinical variables were assessed. In total, 352 patients with an average age of 55 ± 15 (range, 18-86) years were enrolled. RESULTS Expectations scores were not related to age ( P = .36). On average, women expected to achieve complete improvement more often than men ( P = .011). Variables that were significantly associated with higher expectations scores ( P < .05) included nonwhite race, use of a cane or other assistive device, and greater medical comorbidity. Worse function and quality of life (as assessed by all FAOS subscales and the SF-12 physical and mental components), more depressive and anxiety symptoms, and higher pain VAS scores were associated with higher expectations scores and more expectations ( P < .01 for all). CONCLUSIONS The results of this study may help inform surgeons' preoperative discussions with their patients regarding realistic expectations from surgery. Generally, patients with worse function and more disability had higher expectations from surgery. Addressing these patients' expectations preoperatively may help improve their ultimate satisfaction with surgery. LEVEL OF EVIDENCE Level II, cross sectional study.
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Affiliation(s)
- Elizabeth A Cody
- 1 Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Carol A Mancuso
- 2 Clinical Epidemiology, Hospital for Special Surgery, New York, NY, USA
| | - Jayme C Burket
- 3 Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Anca Marinescu
- 4 Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
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Al-Mohrej OA, Alsarhani WK, Al-Mohrej AM, Masuadi EM, Al-Kenani NS. Patient Expectations and Satisfaction With Foot and Ankle Surgery in Saudi Arabia: A Retrospective Cohort Study. J Foot Ankle Surg 2017; 56:65-71. [PMID: 27989348 DOI: 10.1053/j.jfas.2016.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Indexed: 02/03/2023]
Abstract
The success of surgery is associated not only with the quality of the procedure but also with the degree to which it meets the patient's expectations. Limited data are available on patient expectations related to foot and ankle surgery in Saudi Arabia. Our study assessed the preoperative expectations and postoperative satisfaction of patients who had undergone foot and ankle surgery at 1 hospital in Saudi Arabia. A survey-based, retrospective cohort study was conducted among patients who had undergone elective foot or ankle surgery at King Abdul-Aziz Medical City, Riyadh, from January 2010 to December 2015. The participants, who were randomly selected, were interviewed by telephone in April 2016. The average interval between the surgery and the telephone interview was 1 year. We performed stepwise multiple logistic regression analysis to assess the predictors of patient satisfaction with surgery. A total of 383 participants were interviewed (51.7% male). The sample included participants with a wide age range. Most participants had undergone surgery because of pain (74.9%) or movement difficulties (37.1%); only 9.4% had undergone surgery for cosmetic reasons. Most (80%) of the participants reported they were satisfied with the surgical results. Young age, bilateral surgery, efficient pain control, and fulfilled expectations had the greatest positive effects on satisfaction. The findings of the present study will help improve our understanding of the expectations of patients who undergo elective foot and ankle surgery in Saudi Arabia. Additionally, our results can give orthopedic surgeons insight into patients' ideas and concerns regarding their surgery, which might ultimately improve communication between surgeons and patients.
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Affiliation(s)
- Omar A Al-Mohrej
- Researcher, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Medical Intern, Department of Clinical Affaires, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Waleed K Alsarhani
- Researcher, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Medical Intern, Department of Clinical Affaires, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed M Al-Mohrej
- Researcher, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Medical Intern, Department of Clinical Affaires, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Emad M Masuadi
- Researcher, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Assistant Professor, Biostatistic Section, Research Unit, Medical Education Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nader S Al-Kenani
- Researcher, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Medical Intern, Department of Clinical Affaires, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Assistant Professor, Orthopedic Division, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Cody EA, Mancuso CA, MacMahon A, Marinescu A, Burket JC, Drakos MC, Roberts MM, Ellis SJ. Development of an Expectations Survey for Patients Undergoing Foot and Ankle Surgery. Foot Ankle Int 2016; 37:1277-1284. [PMID: 27654045 DOI: 10.1177/1071100716666260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many authors have reported on patient satisfaction from foot and ankle surgery, but rarely on expectations, which may vary widely between patients and strongly affect satisfaction. In this study, we aimed to develop a patient-derived survey on expectations from foot and ankle surgery. METHODS We developed and tested our survey using a 3-phase process. Patients with a wide spectrum of foot and ankle diagnoses were enrolled. In phase 1, patients were interviewed preoperatively with open-ended questions about their expectations from surgery. Major concepts were grouped into categories that were used to form a draft survey. In phase 2, the survey was administered to preoperative patients on 2 occasions to establish test-retest reliability. In phase 3, the final survey items were selected based on weighted kappa values for response concordance and clinical relevance. RESULTS In phase 1, 94 preoperative patients volunteered 655 expectations. Twenty-nine representative categories were discerned by qualitative analysis and became the draft survey. In phase 2, another 60 patients completed the draft survey twice preoperatively. In phase 3, 23 items were retained for the final survey. For retained items, the average weighted kappa value was 0.54. An overall score was calculated based on the amount of improvement expected for each item on the survey and ranged from zero to 100, with higher scores indicating more expectations. For patients in phase 2, mean scores for both administrations were 65 and 66 and approximated normal distributions. The intraclass correlation coefficient between scores was 0.78. CONCLUSION We developed a patient-derived survey specific to foot and ankle surgery that is valid, reliable, applicable to diverse diagnoses, and includes physical and psychological expectations. The survey generates an overall score that is easy to calculate and interpret, and thus offers a practical and comprehensive way to record patients' expectations. We believe this survey may be used preoperatively by surgeons to help guide patients' expectations and facilitate shared decision making. LEVEL OF EVIDENCE Level II, cross-sectional study.
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Affiliation(s)
- Elizabeth A Cody
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Carol A Mancuso
- Clinical Epidemiology, Hospital for Special Surgery, New York, NY, USA
| | - Aoife MacMahon
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Anca Marinescu
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Jayme C Burket
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA
| | - Mark C Drakos
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Matthew M Roberts
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Moraiti C, Klouche S, Stiglitz Y, Hardy P, Bauer T. Reliability of a new radiological method for assessment of the postoperative immobilization of the first metatarsophalangeal joint. Foot Ankle Int 2015; 36:310-7. [PMID: 25344247 DOI: 10.1177/1071100714555713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The success of the operative treatment of mild to moderate hallux valgus (HV) relies greatly on the osseous union of the osteotomies at the desired position. Full weight-bearing is often allowed immediately postoperatively with special forefoot off-loading shoes. No precise methodology exists for the estimation of foot immobilization inside those shoes. The aim of this study was to assess the reliability of a new radiological measurement method to assess the immobilization of the first metatarsophalangeal (M1P1) joint inside a postoperative forefoot off-loading rocker shoe. METHODS A prospective single-center study was conducted during 2012. Patients operated on for mild or moderate HV deformity with a percutaneous technique by the same surgeon were included. Twenty-four patients (33 feet) fulfilled the inclusion criteria, all women and mean age of 56.6 ± 12.7 years. Standard lateral foot X-rays were obtained 1 week postoperatively with the patient standing in 2 positions, wearing the same forefoot off-loading rocker shoe: the foot flat on the ground (imitating midstance) and on the toes (imitating propulsion). The main evaluation criterion was the immobilization of the M1P1 joint estimated through the difference between the values of the M1P1 angle in the sagittal plane in these positions. Validity and reliability of this new measurement were assessed with Pearson's correlation coefficients (r) and intraclass correlation (ICC, ρ) coefficients. RESULTS The inter- and intraobserver reliability of the measurement was excellent to good. The mean M1P1 angle was 17.5 ± 7 degrees in the position imitating the midstance and 20.7 ± 7.5 degrees in the position imitating propulsion (P < 10(-5)). CONCLUSION This new radiological measurement for assessing immobilization of the M1P1 joint was a valid and reliable method.
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Affiliation(s)
- Constantina Moraiti
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France
| | - Shahnaz Klouche
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France
| | - Yves Stiglitz
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France
| | - Philippe Hardy
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France Université de Versailles Saint-Quentin-en-Yvelines, UFR de Santé, Versailles, France
| | - Thomas Bauer
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France
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Younger ASE, Wing KJ, Glazebrook M, Daniels TR, Dryden PJ, Lalonde KA, Wong H, Qian H, Penner M. Patient expectation and satisfaction as measures of operative outcome in end-stage ankle arthritis: a prospective cohort study of total ankle replacement versus ankle fusion. Foot Ankle Int 2015; 36:123-34. [PMID: 25645533 DOI: 10.1177/1071100714565902] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current operative outcome scales are based on pain and function, such as the Ankle Osteoarthritis Scale (AOS). Outcomes based on patient expectation and satisfaction may be more useful. The purpose of this prospective cohort study was to evaluate associations between patient expectation, satisfaction, and outcome scores for ankle fusion and total ankle replacement (TAR). METHODS In total, 654 ankles in 622 patients were analyzed at a mean of 61 months. Patient expectation and satisfaction with symptoms were quantified pre- and postoperatively using the Musculoskeletal Outcomes Data Evaluation and Management Scale questionnaires from the American Academy of Orthopaedic Surgeons, while function was quantified using the AOS. RESULTS Patients undergoing ankle replacement had a higher preoperative expectation score (79; 95% confidence interval [CI], 77-81) compared with those undergoing ankle fusion (72; 95% CI, 68-75). Preoperative expectation scores correlated weakly with AOS scores (R (2) = 0.02) and with the "expectations met" score for ankle fusion (R (2) = 0.07) but not for ankle replacement (R (2) < 0.01). Satisfaction scores were similar for ankle fusion and ankle replacement at follow-up, but a greater number of ankle replacement patients showed improvement in satisfaction (84% vs 74%, P < .005). Higher satisfaction at final follow-up was associated with better expectations met and greater improvement in AOS outcome scores for both ankle fusion and ankle replacement. Expectations met and AOS scores at follow-up correlated for ankle fusion (R (2) = 0.38, P < .0001) and ankle replacement (R (2) = 0.31, P < .0001). CONCLUSIONS Patients undergoing TAR had higher expectation scores prior to surgery than those undergoing ankle fusion. Expectations may be more likely to be met by ankle replacement compared with ankle fusion. Ankle replacement patients were more likely to report improved satisfaction scores after surgery. Preoperative expectation scores showed little correlation with preoperative AOS scores, indicating that expectation is independent of pain and function. However, postoperative expectations met and satisfaction scores were strongly associated with AOS scores at follow-up. Better preoperative patient education may change expectations and requires study. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Alastair S E Younger
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada
| | - Kevin J Wing
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada
| | - Mark Glazebrook
- Department of Orthopedic Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada
| | | | | | | | - Hubert Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hong Qian
- Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Murray Penner
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada
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Dux K, Smith N, Rottier FJ. Outcome after metatarsal osteotomy for hallux valgus: a study of postoperative foot function using revised foot function index short form. J Foot Ankle Surg 2013; 52:422-5. [PMID: 23651697 DOI: 10.1053/j.jfas.2013.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to evaluate patients' perception of their functional outcome at 6 and 12 months after surgical correction for hallux valgus using the Foot Function Index Revised short form. A total of 59 patients underwent 68 osseous and soft tissue procedures for the correction of hallux valgus deformity from January 2009 through December 2010. The outcome analysis was based on the validated patient questionnaire, the Foot Function Index Revised. The preoperative data were collected on the day of the patient's surgery using the Foot Function Index Revised short-form questionnaire. The postoperative data were collected at 6 and 12 months after the patient's initial surgical date using the same validated questionnaire. The cumulative Foot Function Index Revised score and the scores in each subscale demonstrated statistically significant data at both 6 and 12 months of follow-up. On average, the Foot Function Index Revised scores had improved by 39% at 6 months and 50% at 12 months. The improvement in all scores indicated an improvement in health-related foot function after hallux valgus surgery, evidencing effective surgical intervention. Expectations are the best predictors of patient satisfaction, and the present study has provided statistically significant data to allow physicians to establish realistic outcomes after surgical correction for hallux valgus deformity.
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Affiliation(s)
- Katherine Dux
- Instructor, Podiatric Medicine and Surgery, Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Stritch School of Medicine, Maguire Center, Maywood, IL 60153, USA.
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Di Giorgio L, Touloupakis G, Simone S, Imparato L, Sodano L, Villani C. The Endolog system for moderate-to-severe hallux valgus. J Orthop Surg (Hong Kong) 2013; 21:47-50. [PMID: 23629987 DOI: 10.1177/230949901302100113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report the midterm outcome of the Endolog system for correction of moderate-to-severe hallux valgus. METHODS 23 women and 2 men (33 feet) aged 35 to 80 (mean, 52) years underwent minimally invasive surgery for moderate (n=25) and severe (n=8) hallux valgus using the Endolog system. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the proximal articular set angle (PASA) were measured on radiographs. The feet were also assessed based on the American Orthopaedic Foot and Ankle Society (AOFAS) scale. RESULTS The mean follow-up duration was 18.2 (range, 12-36) months. The mean HVA, IMA, PASA, and the mean AOFAS score improved significantly after surgery (all p<0.0001). Periosteal reaction was noted by week 4, and callus formation after 3 months. There were no delayed or non-union or other complications. CONCLUSION The Endolog system achieved good outcome for moderate-to-severe hallux valgus.
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Affiliation(s)
- Luigi Di Giorgio
- Dipartimento di Scienze dell' Apparato Locomotore, Policlinico Umberto I, Universita' Sapienza, Roma, Italy.
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Maher AJ, Kilmartin TE. An analysis of Euroqol EQ-5D and Manchester Oxford Foot Questionnaire scores six months following podiatric surgery. J Foot Ankle Res 2012; 5:17. [PMID: 22776703 PMCID: PMC3489846 DOI: 10.1186/1757-1146-5-17] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 06/22/2012] [Indexed: 11/10/2022] Open
Abstract
Background In the United Kingdom patient-reported outcome measures (PROMS) have been adopted as a key measure of foot surgery outcomes. The intention of this study was to evaluate the responsiveness of a regional outcome measure; the Manchester Oxford Foot Questionnaire (MOXFQ) and a generic measure; the EuroQol EQ-5D, in the context of day care Podiatric Surgery. Methods A prospective audit of 375 consecutive day care surgical admissions was undertaken. All patients attending for surgery, who agreed to participate, were included. Pre operation patients completed the MOXFQ and the EQ-5D. Both questionnaires were completed again at 6 months post operation. Additional data was collected on patient demographics, surgical procedures and complications. Results Few complications were encountered and most patients (84%) returned for a final review 6 months post operation. Mean MOXFQ scores improved for each domain: pain; 51.7 pre-operation, reduced to 16.5 post-operation, walking; 50.2 reduced to 14.1 and social interaction; 45.7 reduced to 10.6. The minimal clinically important differences (MCID) estimates for the pain domain were exceeded by 82.6% of patients, while 74.8% exceeded the MCID for walking and 68.5% exceeded the MCID for social interaction. A small number of patients (2.9%) deteriorated across all three MOXFQ domains. The EQ-5D Index, summary of health related quality of life, improved from 0.66 pre-operation to 0.86 post operation. The EQ-5D index MCID was exceeded by 79.2% of patients. Index scores deteriorated for 1.8% of patients following surgery. Effect sizes measured following surgery were largest for the MOXFQ domains: Walking; 1.39, Pain; 1.52 and Social Interaction: 1.39. The EQ-5D index effect size was 0.83. The EQ-5D visual analogue scale (VAS) was not influenced by surgery. Conclusion Both the MOXFQ and EQ-5D index (but not the VAS) appear sensitive to changes in health status at 6 months following elective foot surgery. Both instruments were particularly responsive to changes in pain, mobility and activity or social interaction following treatment. The MOXFQ was developed specifically for foot surgery and as such appears to be the more sensitive instrument. However the generic EQ-5D may allow comparison of general health states in the wider health community. Both instruments when used together appear well suited to the measurement of change in perceived health status following foot surgery.
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Affiliation(s)
- Anthony J Maher
- Department of Podiatric Surgery, County Health Partnerships, Park House Health and Social Care Centre, Burton Road, Carlton, Nottingham, NG4 3DQ, UK.
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Groarke P, Galvin R, Kelly J, Stephens MM. Quality of life in individuals with chronic foot conditions: a cross sectional observational study. Foot (Edinb) 2012; 22:66-9. [PMID: 22265453 DOI: 10.1016/j.foot.2011.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 08/15/2011] [Accepted: 11/17/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic foot conditions have been reported to be a significant cause of impairment and disability to individuals affected. However, studies to date have particularly focussed on patient satisfaction with outcomes following surgery. OBJECTIVES The aim of this study is to examine the impact of three common foot conditions on the levels of impairment and quality of life prior to surgery. Three conditions include Hallux Valgus (HV), Hallux Rigidus (HR) and Hammer Toe (HT). METHODS This was a pilot cross-sectional observational study of people who were radiologically and clinically diagnosed with one of the three common foot pathologies: HV, HR and HT. Age and gender matched controls were also recruited. Self-reported quality of life was measured. RESULTS The SF-36 scores did not differ significantly between the groups. There was a significant difference in self reported impairment between the groups on the Global Foot and Ankle Scale indicating that the 'bilateral foot group' perceived themselves to be significantly more impaired than their counterparts in the control group. CONCLUSION Patient quality of life is now recognised as one of the most important outcomes of surgery. These findings serve to highlight the level of impairment and quality of life of individuals prior to surgery.
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Affiliation(s)
- Patrick Groarke
- National Orthopaedic Hospital, Cappagh, Finglas, Dublin 9, Ireland. patrick
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Wilkinson AN, Maher AJ. Patient expectations of podiatric surgery in the United Kingdom. J Foot Ankle Res 2011; 4:27. [PMID: 22145971 PMCID: PMC3251527 DOI: 10.1186/1757-1146-4-27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 12/06/2011] [Indexed: 11/29/2022] Open
Abstract
Background Patient expectations can be difficult to conceptualise and are liable to change with time, health and environmental factors. Patient expectation is known to influence satisfaction, however little is known about the expectations of patients attending for podiatric surgery. This paper will explore the expectations of a large cohort of patients undergoing elective foot surgery. Methods The UK based podiatric audit of surgery and clinical outcome measurement (PASCOM) audit system was applied to a consecutive cohort of patients undergoing elective podiatric surgery in Doncaster, South Yorkshire between 2004 and 2010. Data was collected relating to the surgical episode and patient expectations. A patient questionnaire was administered at 6 months post intervention. Results A total of 2910 unique surgical admissions were completed and satisfaction questionnaires were returned by 1869 patients. A total of 1430 patients answered question 1 which relates to patient expectations. Pain relief was the most frequent expectation with 1191 counts (52.3%), while footwear and mobility accounted for 16.6% and 16.4% respectively. Cosmesis counts occurred less commonly; 12.2%. 709 patients (49.6%) stated only a single expectation, 599 patients (41.9%) stated two expectations, 114 patients (8%) stated three expectations and 7 patients (0.5%) stated 4 expectations. Pain relief was the dominant expectation accounting for 515 counts (72.6%) of patients who provided only one response. Conclusions This paper demonstrates the expectations of a large cohort of podiatric surgery patients. For the most part patients expect pain relief, improved mobility and improved shoe fitting, while a small number of patients also expect a cosmetic improvement. Further research is required to determine the relationship between patient expectation and health related quality of life, and to determine whether podiatric surgery is successful in addressing the expectations of patients.
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Affiliation(s)
- Antony N Wilkinson
- Department of Podiatric Surgery, Park House Health and Social Care Centre, 61 Burton Road, Carlton, Nottingham, NG4 3DQ, UK.
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Spruce MC, Bowling FL, Metcalfe SA. A longitudinal study of hallux valgus surgical outcomes using a validated patient centred outcome measure. Foot (Edinb) 2011; 21:133-7. [PMID: 21316938 DOI: 10.1016/j.foot.2011.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/12/2011] [Accepted: 01/14/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus is a common chronic condition affecting up to a third of the population. Progressive disruption to the complex anatomy of the first ray involving metatarsal, sesamoids and hallux impose both structural and functional alteration to the foot which underpin the secondary pathologies associated with this condition. It is common for patients to seek correction of the deformity in order to alleviate pain and improve footwear tolerance. Surgical intervention remains the only viable means to restore osseous alignments. To date there remains no universally accepted standards for procedure selection. METHODS A total of 179 consecutive participants were recruited into the study. Ethical approval was obtained and all participants consented to participate in the study, in accordance with the Helsinki Declaration. All patients attending the Department of Podiatric Surgery, between July 2004 and October 2007 for the surgical management of hallux valgus were invited to complete a Foot Health Status Questionnaire. Pre-operative data collection on all participants was undertaken on the day of admission, using the validated Foot Health Status Questionnaire measurement tool as with previous studies. RESULTS A total of 179 complete data sets were recorded in this longitudinal study with an average participant age of 49.4 years (SD 14.5). The group comprised 164 females and 15 males. The mean days for administration of the Foot Health Status Questionnaire post operative follow up was 1045 days (149 weeks or 2.9 years). The results demonstrated that within all four foot specific domains, the minimal important differences were achieved by the majority of the group. Meanwhile, in domains relating to general health, physical activity, vigour and social capacity, the majority of participants failed to attain the calculated minimal important difference (94 [53%], 96 [54%], 93 [52%], 93 [52%], respectively). CONCLUSIONS The authors have presented for the first time minimal important difference for all eight domains for the Foot Health Status Questionnaire quality of life tool in respect to hallux valgus surgery. Results demonstrate that surgical correction of hallux valgus undertaken under local anaesthetic as a Day Case procedure is an effective intervention directly benefiting patients by reducing perceived foot pain, improving foot function and general foot health for the majority of patients.
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Affiliation(s)
- Michelle C Spruce
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, UK.
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