Quality-of-life outcome after hallux valgus surgery

Objective To assess the quality of life before and after hallux valgus surgery. Methods A longitudinal study with 94 consecutive patients undergoing hallux valgus surgery. Assessments were made preoperatively and at 12 month postoperatively. Measures used were the quality of life (QoL) according to SF-36, a disease specific score (the American Orthopaedic Foot and Ankle Society’s clinical rating system for the hallux), the severity of the deformity, the possibility of wearing the preferred choice of shoes and satisfaction with the treatment. The pre- and postoperative QoL scores were compared with the score in the general population. Results QoL outcomes improved significantly postoperatively regarding bodily pain, vitality, mental health and the mental component summary. The correction of the deformity did not affect the QoL. Regardless of the extent of correction, the choice of shoeware and the degree of satisfaction with surgery were associated with a better QoL. Conclusions Hallux valgus patients have worse pain than the general population. Surgery produces a significant improvement in the quality of life. The severity of the deformity did not influence the QoL, however; the free choice of shoeware and the degree of satisfaction with the surgery had a positive effect on the QoL outcome. SF-36 is a relevant tool for evaluating outcome in hallux valgus surgery.     

一种新的(足,母)外翻矫形术--第一跖骨斜行截骨术的疗效分析

目的探讨和总结第一跖骨斜行截骨术治疗外翻畸形的临床效果和优越性.方法对一组46例54足术前常规摄前足负重正位片测量外翻角(HVA)、跖间角(IMA)、近侧关节固角(PASA).全部病例均施第一跖骨斜行截骨术19例联合趾近节趾骨楔型截骨术,6例联合其他跖骨截骨矫正外翻畸形.结果随访6.2～44.0个月,平均19.6个月.所有外翻畸形足全部矫正,术后前足负重正位片测的HVA,IMA和PASA与术前相比有明显差异(P<0.01),优良率达94.4%.发生第一跖骨骨折1例.结论第一跖骨斜行截骨术对于矫正外翻畸形较之其他术式的适用范围更广,不仅可以单独使用,也可和其他术式联合使用,且操作简单,固定牢固,可行早期功能锻炼,并发症少.对重度畸形者更显其优越性.     

A patient-based questionnaire to assess outcomes of foot surgery: Validation in the context of surgery for hallux valgus

Background: A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery. Methods: We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the ‘Manchester-Oxford Foot Questionnaire’ (MOXFQ)), consisting of three domains/scales: ‘Walking/standing’ (seven items), ‘Pain’ (five items) and ‘Social interaction’ (four items) each having good measurement properties. All three domains were unidimensional. Conclusions: The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.