BACKGROUND Hallux valgus(HV)is a common foot deformity that manifests with increasing age,especially in women.The associated foot pain causes impaired gait and decreases quality of life.Moderate and severe HV is a def...BACKGROUND Hallux valgus(HV)is a common foot deformity that manifests with increasing age,especially in women.The associated foot pain causes impaired gait and decreases quality of life.Moderate and severe HV is a deformity that is charac-terized by the involvement of lesser rays and requires complex surgical treatment.In this study,we attempted to develop a procedure for this condition.AIM To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity.METHODS We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor’s bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems.This method included a modified Lapidus procedure,M2M3 tarsometatarsal arthrodesis,intermetatarsal fusion of the M4 and M5 bases,and the use of an original external fixation apparatus to enhance correction power.Preoperative,postoperative,and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society(AOFAS)scores were compared,and P values<0.05 were considered to indicate statistical significance.RESULTS The study included 28 females(93.3%)and 2 males feet(6.7%),20(66.7%)of whom had a moderate degree of HV and 10(33.3%)of whom had severe deformity.M2 and M3 metatarsalgia was observed in 21 feet,and 9 feet experienced pain only at M2.The mean follow-up duration was 11 months.All patients had good correction of the HV angle[preoperative median,36.5 degrees,interquartile range(IQR):30-45;postoperative median,10 degrees,IQR:8.8-10;follow-up median,11.5 degrees,IQR:10-14;P<0.01].At follow-up,metatarsalgia was resolved in most patients(30 vs 5).There was a clinically negligible decrease in the corrected angles at the final follow-up,and the overall AOFAS score was significantly better(median,65 points,IQR:53.8-70;vs 80 points,IQR:75-85;P<0.01).CONCLUSION The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up.Randomized clinical trials with larger samples,as well as long-term outcome assessments,are needed in the future.展开更多
AIM:To define footwear outcomes following hallux valgus surgery,focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection.METHODS:Surgical intervention is indicate...AIM:To define footwear outcomes following hallux valgus surgery,focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection.METHODS:Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods,with favourable reported outcomes.The return to various types of footwear postoperatively is reflective of the degree of correction achieved,and corresponds to patient satisfaction.Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms.Many female patients will additionally attempt to return to high-heeled,narrow toe box shoes.However,minimal evidence exists to guide their expectations.Sixtyfive female hallux valgus patients that had undergone primary surgery bet ween 2011 and 2013 were retrospectively identified using our hospital surgical database.Patients were reviewed using a footwearspecific outcome questionnaire at a mean 18.5 mo follow-up.RESULTS:Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort.Of those intending to resume wearing heeled footwear,62%were able to do so,with 77%of these patients wearing these as or more frequently than pre-operatively.No significant difference was observed between pre-and post-operative heel size.Mean time to return to heeled footwear was 21.4wk post-operation.Cosmetic outcomes were very high and did not adversely impact footwear selection.CONCLUSION:We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery.We observed an"all-ornone phenomenon"where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively.A minority of patients were unable to return to comfortable footwear post-operatively,which had adverse ramifications on their quality-of-life.We recommend that the importance of managing patient expectations through appropriate pre-operative counselling be emphasized in forefoot surgery.展开更多
文摘BACKGROUND Hallux valgus(HV)is a common foot deformity that manifests with increasing age,especially in women.The associated foot pain causes impaired gait and decreases quality of life.Moderate and severe HV is a deformity that is charac-terized by the involvement of lesser rays and requires complex surgical treatment.In this study,we attempted to develop a procedure for this condition.AIM To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity.METHODS We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor’s bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems.This method included a modified Lapidus procedure,M2M3 tarsometatarsal arthrodesis,intermetatarsal fusion of the M4 and M5 bases,and the use of an original external fixation apparatus to enhance correction power.Preoperative,postoperative,and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society(AOFAS)scores were compared,and P values<0.05 were considered to indicate statistical significance.RESULTS The study included 28 females(93.3%)and 2 males feet(6.7%),20(66.7%)of whom had a moderate degree of HV and 10(33.3%)of whom had severe deformity.M2 and M3 metatarsalgia was observed in 21 feet,and 9 feet experienced pain only at M2.The mean follow-up duration was 11 months.All patients had good correction of the HV angle[preoperative median,36.5 degrees,interquartile range(IQR):30-45;postoperative median,10 degrees,IQR:8.8-10;follow-up median,11.5 degrees,IQR:10-14;P<0.01].At follow-up,metatarsalgia was resolved in most patients(30 vs 5).There was a clinically negligible decrease in the corrected angles at the final follow-up,and the overall AOFAS score was significantly better(median,65 points,IQR:53.8-70;vs 80 points,IQR:75-85;P<0.01).CONCLUSION The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up.Randomized clinical trials with larger samples,as well as long-term outcome assessments,are needed in the future.
文摘AIM:To define footwear outcomes following hallux valgus surgery,focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection.METHODS:Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods,with favourable reported outcomes.The return to various types of footwear postoperatively is reflective of the degree of correction achieved,and corresponds to patient satisfaction.Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms.Many female patients will additionally attempt to return to high-heeled,narrow toe box shoes.However,minimal evidence exists to guide their expectations.Sixtyfive female hallux valgus patients that had undergone primary surgery bet ween 2011 and 2013 were retrospectively identified using our hospital surgical database.Patients were reviewed using a footwearspecific outcome questionnaire at a mean 18.5 mo follow-up.RESULTS:Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort.Of those intending to resume wearing heeled footwear,62%were able to do so,with 77%of these patients wearing these as or more frequently than pre-operatively.No significant difference was observed between pre-and post-operative heel size.Mean time to return to heeled footwear was 21.4wk post-operation.Cosmetic outcomes were very high and did not adversely impact footwear selection.CONCLUSION:We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery.We observed an"all-ornone phenomenon"where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively.A minority of patients were unable to return to comfortable footwear post-operatively,which had adverse ramifications on their quality-of-life.We recommend that the importance of managing patient expectations through appropriate pre-operative counselling be emphasized in forefoot surgery.
