Predictors of Outcome in Hallux Valgus Surgery

Introduction: Hallux valgus (HV) is the most common forefoot deformity, and is known to be a debilitating disease, causing pain and reduced social function. There are various established surgical treatments for HV, with patient satisfaction up to 85% after surgery. In this paper, we aim to identify the pre-operative factors that may serve as predictors to patient outcome after surgery, to help surgeons select suitable candidates for surgery in the clinic. Methods: A prospective study was done on patients who underwent scarf and akin osteotomy for symptomatic HV between October 2015 and March 2018. Five patient factors were collected pre-operatively, including osteoarthritis grade of first metatarsophalangeal joint, severity of HV, presence of osteoarthritic or sesamoid pain, and presence of flat foot. Patient’s self-reported outcomes was assessed pre- and post-surgery, using the Manchester-Oxford Foot Questionnaire (MOXFQ) and Visual Analogue Score (VAS). Pre- and post-surgery outcome scores were compared, and changes in scores analysed with numerous patient factors to identify any significant association. Results: 41 feet of 36 patients were included after implementation of exclusion criteria. Both MOXFQ and VAS showed a significant reduction in scores (improvement in outcomes) after surgery. None of the pre-operative patient factors examined was found to be significantly associated with the reduction in MOXFQ score. However, the results suggested that high pre-surgery MOXFQ score was associated with a greater MOXFQ score reduction post-surgery, with p-value of <0.001. Conclusion: Our study found that none of the factors looked at significantly correlated with reductions in MOXFQ and VAS scores post-surgery, other than high presurgery MOXFQ scores. This suggests that surgeons should counsel as such in clinic. Nonetheless, as this study had a small study size, further studies should be done to support the findings of this research.