Pre- and Post-Operative Relationship between Radiological Measures and Clinical Outcomes in Women with Hallux Valgus

Abstract

The surgical correction of a hallux valgus (HV) deformity improves radiological parameters and clinical outcomes. However, it is not known how these improvements are related between themselves. In this retrospective study, 73 women were assessed preoperatively and 60 months after HV surgical correction. Several radiological parameters were measured: the hallux valgus angle (HVA), I–II intermetatarsal angle (IMA) and sesamoid position. The functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal (HMI) scale, and patient-reported outcomes (PROMs) were recorded with the Manchester–Oxford Foot Questionnaire (MOXFQ). A pre–post-surgery comparison of radiological and clinical values was performed, the correlation among them was studied and the differences pre–post-surgery in the radiological measurements compared with those for the clinical outcomes were studied. The results show that all the radiological parameters, functional outcomes and PROMs improved significantly from their pre-operative values to the follow-up values. Multivariate regression analysis showed a significant relationship (p < 0.001) between the differential pre–post-surgery AOFAS scoring only with two sesamoid position differential pre–post-surgery measures: position of medial sesamoid (PMS) and translation of the first metatarsal head (TMH). However, no significant association was observed between the pre–post-surgery radiological differences and the pre–post-surgery MOXFQ scoring.

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

“…With the use of a MIIND, Biz et al [ 13 ] found an improvement in AOFAS score from 57.9 preoperatively to 90.5 after a mean of 96 months postoperatively. Motta et al [ 20 ] found a pre-to-post difference of 54 points 6 years after the operation (from 35 to 90 points). Castellini et al [ 9 ] reported pre- to postoperative changes in AOFAS scores from 47.3 to 87.0 points, respectively, 2 years after surgery.…”

“…We did not radiologically assess at any time point possible changes. However, we aimed to study only clinical score changes, and several publications have shown no significant correlation between radiological and clinical findings in patients with HV [ 16 , 20 , 21 , 36 ]. Moreover, some authors have reported that predictors of patient satisfaction include subjective outcomes, such as those assessed by the AOFAS score and the Short Form 36 composite quality of life scale, rather than objective radiological outcomes [ 21 ].…”

“…In the past, authors have reported HV surgery results considering the radiological correction of deformities. However, sufficient evidence now suggests that radiological improvement is unrelated to patient satisfaction or clinical outcomes [ 1 , 16 , 20 , 21 ]. Distal linear metatarsal osteotomy improves foot-related quality of life in patients with HV deformity despite a high rate of postoperative radiographic complications, especially hallux varus [ 22 ].…”

“…Its disadvantages include the incorporation of physical examination parameters that have shown poor inter- and intra-observer reliability, the lack of self-administration thereby increasing the risk of bias, and the use of a single question regarding pain [ 25 ]. However, several authors reported significant improvements in AOFAS scores after MIS for HV correction [ 4 , 9 , 20 , 26 , 27 , 28 ].…”

“…Studies examining MOXFQ scores after MIS for HV correction demonstrated that all patients reported significant improvements between preoperative and final follow-up states. Most authors followed their patients for 2 years or less [ 18 , 33 , 34 , 35 , 36 ], but some followed them for at least 5 years [ 20 , 37 ]. All these studies compare the preoperative values with those of the final follow-up.…”