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Friday, March 17, 2000

Patient satisfaction after hallux valgus surgery

A multi-center prospective study, conducted by the American Orthopaedic Foot and Ankle Society, demonstrates a significant improvement in a patient's perception of foot pain, function, shoe comfort and satisfaction following hallux valgus surgery at short-term follow-up.

Scientific paper 17, presented Wednesday, reported that at the time the paper was prepared, 305 patients had enrolled in the study. As of this writing, 179 of these patients have completed a six-month follow-up questionnaire and 180 had completed a one-year follow-up questionnaire that uses the validated MODEMS outcome survey instrument. The data has been evaluated using the Passport software.

At six-month follow-up, significant improvement has been noted in the patients' SF-36 physical function scores, role physical scores, bodily pain scores, and role emotional scores. The MODEMS scores for the lower extremity for physical health and pain and satisfaction with symptoms have significantly improved.

"This study is the first outcome study to evaluate the patient perception of hallux valgus surgery and demonstrates a significant improvement in multiple areas of patient pain, function and satisfaction," said David B. Thordarson, MD, associate professor, department of orthopaedics, University of Southern California.

The inclusion criteria for this study are:

  1. Patient having pain pre-operatively unresponsive to conservative shoe-wear modifications;
  2. The patient must have a hallux valgus greater than 20 degrees;
  3. More than 18 years of age; and
  4. No inflammatory arthritis.

In addition, the surgery performed had to be one of three types:

  1. Distal metatarsal osteotomy;
  2. Proximal metatarsal osteotomy with distal soft tissue realignment; or
  3. Metatarsocuneiform fusion with distal soft tissue realignment.

The patients filled out a baseline MODEMS foot and ankle instrument before surgery, which included the lower extremity core document and the foot and ankle module, which was mailed to the principal investigator. Patients subsequently were asked to complete a six-month postoperative questionnaire, 12-month postoperative questionnaire, and 24-month questionnaire, which are mailed from the principal investigator's office.

SF-36 subscale scores were calculated by the Passport software from the MODEMS questionnaire. Of the ten sub-scores, four had a significant improvement from preoperative to six-month follow-up. There was less than a five point difference for the sub-scales on general health, vitality, social function, mental health, physical composite score and mental composite scores. A power study with alpha at 0.05 with 80 percent power demonstrated that to show a five point difference in any of these SF-36 subscales, 171 to 366 questionnaires would be needed. A greater than five-point improvement was noted for the following, with preoperative scores presented first and six month follow-up scores, second:

The general population score for females with average health age 45-54 (the average age was 49 and significant majority were female) for the above scales is:

The lower extremity core module also generates three scores on physical health and pain, treatment expectations and satisfaction with symptoms. Physical health and pain improved from 66.3 to 77.5; treatment expectations remained essentially unchanged from 82.9 to 77.6; satisfaction of symptoms improved from 1.7 to 3.4 (one to five scale).

Two separate scores are generated for the foot and ankle module. The global foot and ankle scale improved from 75.8 to 90.7. The shoe comfort improved from 34.3 to 54.8.

Although the results are preliminary with only six-month follow-up, the principal investigator anticipates the scores will continue to improve because many patients continue improving beyond six months following their bunion surgery as edema continues to resolve after this point in time and pain continues to improve. Further evaluation of data will include multiple comparisons of outcome scores evaluating the patient's perception of im-provement with the three different types of surgery and the change in their hallux valgus angles and internetatarsal angles pre- and postoperatively. In addition, an analysis of various subscale scores such as patients with impaired emotional function preoperatively will be compared to those without impaired emotional function, etc.

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Last modified 17/March/2000 by IS