The influence of concomitant hammertoe correction on postoperative outcomes in patients undergoing hallux valgus correction |
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| Institution: | 1. Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States;2. Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States;1. Department of Orthopeadic Surgery, Xiangya Hospital Central South University, China;2. Department of Orthopedic Surgery, The First Affliated Hospital, College of Medicine, Zhejiang University, China;3. Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, China;1. Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, 179 Guduk-ro, Seo-gu, Busan 49242, Republic of Korea;2. Department of Orthopedic Surgery, Pusan National University Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea;1. Graduate School of Health Sciences, Sapporo Medical University, South-1, West-17, Chuo-ku, Sapporo, 0608556, Hokkaido, Japan;2. Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, South-1, West-17, Chuo-ku, Sapporo, 0608556, Hokkaido, Japan;3. Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-17, Chuo-ku, Sapporo, 0608556, Hokkaido, Japan;1. Schön Klinik München Harlaching — FIFA Medical Centre, 81547 Munich, Germany;2. Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany;1. Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan;2. Department of Orthopedic Surgery, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1, Imazuyamanaka-Cho, Nishinomiya 663-8211, Japan;3. Faculty of Nursing, Osaka Medical and Pharmaceutical University, 7-6, Hatchonishi-machi, Takatsuki 569-0095, Japan |
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| Abstract: | BackgroundPatients with hallux valgus often develop secondary hammertoe deformities of the lesser toes. Operative management of bunions with hammertoe can be more extensive; however, it is unclear whether this affects patient-reported outcomes. The aim of this study was to compare postoperative patient-reported outcome measures and radiographic outcomes between patients who underwent isolated bunion correction and patients who underwent simultaneous bunion and hammertoe correction.MethodsPreoperative, postoperative, and change in Patient-Reported Outcomes Measurement Information System (PROMIS) scores were compared between patients who underwent isolated hallux valgus correction and those who underwent concomitant hammertoe correction. Radiographic measures including hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal-articular angle (DMAA), and Meary’s angle were also compared. Targeted minimum-loss estimation (TMLE) was used for statistical analysis to control for confounders.ResultsA total of 221 feet (134 isolated bunion correction, 87 concomitant hammertoe correction) with a minimum of 12 months follow-up were included in this study. Both cohorts demonstrated significant improvements in the physical function, pain interference, pain intensity, and global physical health PROMIS domains (all p < 0.001). However, patients in the concomitant hammertoe cohort had significantly less improvements in pain interference and pain intensity (p < 0.01, p < 0.05 respectively). The concomitant hammertoe cohort also had significantly higher postoperative pain interference scores than the isolated bunion cohort (p < 0.01). Radiographic outcomes did not differ between the two groups.ConclusionWhile both isolated bunion correction and concomitant hammertoe correction yielded clinically significant improvements in patient reported outcomes and normalized radiographic parameters, patients undergoing simultaneous bunion and hammertoe correction experienced substantially less improvement in postoperative pain-related outcomes than those who underwent isolated bunion correction. |
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| Keywords: | Hallux valgus Hammertoe Bunionectomy Lapidus Scarf osteotomy Patient-reported outcomes PROMIS |
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