Age adjusted baseline data for women with hallux valgus undergoing corrective surgery. J Bone Joint Surg

Department of Orthopaedic Surgery, University of Southern California, 1200 North State Street, GNH 3900, Los Angeles, CA 90033, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 01/2005; 87(1):66-75. DOI: 10.2106/JBJS.B.00288
Source: PubMed


Functional and health-related quality-of-life data on a population of patients with hallux valgus are lacking. Similarly, the correlation of the severity of the deformity with these measures is unknown.
Two hundred and eighty-five women with an average age of forty-nine years who were scheduled for bunion surgery were enrolled in the study. The patients completed a baseline American Academy of Orthopaedic Surgeons (AAOS) foot and ankle outcomes questionnaire, which includes the Short Form-36 (SF-36) and a specific lower-extremity section on the foot and ankle. Preoperative radiographic data with regard to the hallux valgus angle and the intermetatarsal angle were stratified into groups according to the severity of the deformity (mild, moderate, or severe). The data were then stratified into age-groups consistent with those reported for the SF-36, and the results were compared with the SF-36 scores for the general population. The global foot and ankle score and the shoe comfort score were compared with general population scores that were published previously. The severity of the preoperative deformity was correlated with the baseline scores.
General health scores were noted to be relatively stable throughout the age-groups for patients with bunions, with the older groups demonstrating better scores than the general population. Bodily pain scores were consistently worse for patients with a bunion through all age-groups compared with the general population. The average global foot and ankle score and the shoe comfort score were significantly lower (p < 0.001 for both) for the patients with a bunion than for the general population. The severity of the preoperative deformity did not correlate with any of the outcome scores.
The bodily pain score from the SF-36 appears to be a sensitive measure of problems experienced by patients undergoing bunion surgery. Surprisingly, the severity of the deformity as measured radiographically did not correlate with any of the fifteen scores measured. These data may serve as a baseline for clinical hallux valgus studies with use of the SF-36 or the AAOS outcomes questionnaire.

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    • "Studies of older people have demonstrated that foot pain is associated with decreased ability to undertake activities of daily living [4-9], problems with balance and gait [7,10,11] and an increased risk of falls [12-16]. Furthermore, several clinic-based studies assessing health-related quality of life across a range of age-groups have shown that people with foot disorders (such as generalized foot pain [2,17], nail infections [18-20], hallux valgus [21,22] hallux rigidus [23] and plantar heel pain [24]) demonstrate significantly lower scores than those without these conditions. A range of risk factors for foot problems has been identified, including increased age [25-27], female sex [7,8,26,28], obesity [8,10,28,29], and chronic conditions such as osteoarthritis and diabetes [8,10,29]. "
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    ABSTRACT: Background Foot pain is highly prevalent in older people, and in many cases is associated with wearing inadequate footwear. In Australia, the Department of Veterans’ Affairs (DVA) covers the costs of medical grade footwear for veterans who have severe foot deformity. However, there is a high demand for footwear by veterans with foot pain who do not meet this eligibility criterion. Therefore, this article describes the design of a randomized controlled trial to evaluate the effectiveness of low cost, off-the-shelf footwear in reducing foot pain in DVA recipients who are currently not eligible for medical grade footwear. Methods One hundred and twenty DVA clients with disabling foot pain residing in Melbourne, Australia, who are not eligible for medical grade footwear will be recruited from the DVA database, and will be randomly allocated to an intervention group or a ‘usual care’ control group. The intervention group will continue to receive their usual DVA-subsidized podiatry care in addition to being provided with low-cost, supportive footwear (Dr Comfort®, Vasyli Medical, Labrador, Queensland, Australia). The control group will also continue to receive DVA-subsidized podiatry care, but will not be provided with the footwear until the completion of the study. The primary outcome measure will be pain subscale on the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8, 12 and 16 weeks. Secondary outcome measures measured at baseline and 16 weeks will include the function subscale of the FHSQ, the Manchester Foot Pain and Disability Index, the number of DVA podiatry treatments required during the study period, general health-related quality of life (using the Short Form 12® Version 2.0), the number of falls experienced during the follow-up period, the Timed Up and Go test, the presence of hyperkeratotic lesions (corns and calluses), the number of participants using co-interventions to relieve foot pain, and participants’ perception of overall treatment effect. Data will be analyzed using the intention-to-treat principle. Discussion This study is the first randomized controlled trial to evaluate the effectiveness of off-the-shelf footwear in reducing foot pain in DVA recipients. The intervention has been pragmatically designed to ensure that the study findings can be implemented into policy and clinical practice if found to be effective. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12612000322831
    Trials 04/2013; 14(1):106. DOI:10.1186/1745-6215-14-106 · 1.73 Impact Factor
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    ABSTRACT: Mitchell's osteotomy gives very good results but there are still some cases where the original method, as well as its modification, cannot address all aspects of deformity. We modified the original Mitchell's method to address pronation and plantar displacement of the first metatarsal. Modification includes formation of lateral and plantar spur with metatarsal displacement and derotation of distal metatarsal fragment in the frontal and horizontal planes with stable screw fixation. We present midterm results of the first 60 patients compared to the original Mitchell method (30 patients). Differences between the groups postoperatively were in declination angle, postoperative metatarsalgia rate, and first metatarsal pronation angle. The technique described eliminated many of the disadvantages of Mitchell's method.
    Journal of the American Podiatric Medical Association 03/2009; 99(2):162-72. DOI:10.7547/0980162 · 0.65 Impact Factor
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    ABSTRACT: Introduction Le traitement chirurgical de l’hallux valgus, déformation à prédominance féminine associant abduction et pronation de la première phalange, adduction, pronation et élévation du premier métatarsien ainsi qu’une rétraction capsuloligamentaire métatarsophalangienne latérale, ne doit être proposé qu’en cas de douleur ou de conflit lors du chaussage après échec d’un traitement médical. Parmi les traitements chirurgicaux de l’hallux valgus, les ostéotomies métatarsiennes occupent une place prépondérante et restent les plus pratiquées de nos jours. Nous nous intéresserons ici à la technique hybride par ostéotomie métatarsienne distale en chevron par voie mini-invasive associée à une varisation percutanée de la première phalange, en exposant les complications éventuelles de cette technique et en analysant l’intérêt précoce respectif de l’ostéotomie métatarsienne ainsi que de l’ostéotomie phalangienne. Matériel et méthode Notre étude porte sur une série prospective continue monocentrique mono-opérateur de 31 cas d’hallux valgus opérés selon la même technique miniinvasive chez 24 patients avec évaluation clinique et radiologique à 15 mois de recul sans perdus de vue. La série se compose de 21 femmes et de trois hommes dont la moyenne d’âge est de 47 ans, opérés entre janvier 2010 et juillet 2011. Résultats La reprise d’un chaussage normal était effectuée en moyenne à six semaines postopératoires. Le pourcentage de satisfaction des patients est de 79 %. La durée moyenne de l’acte opératoire est de 39 minutes. Le score fonctionnel de l’AOFAS (American Foot and Ankle Society) [4] a été amélioré de façon significative passant d’une valeur médiane préopératoire de 26,4 sur 100 à une valeur médiane postopératoire de 86,2 sur 100 au dernier recul. Nous notons trois cas de douleurs décrites en regard de la tête de vis de la première phalange. L’angle intermétatarsien M1M2 est passé de 14,7° en préopératoire à 11° en postopératoire. L’angle articulaire métatarsien distal (distal metatarsal articular angle, DMAA) a également diminué en passant de 15,9 à 7,3°. Conclusion Bien qu’à l’origine de nombreuses difficultés techniques, le traitement de l’hallux valgus moyen à modéré par ostéotomie métatarsienne distale en chevron selon une technique mini-invasive a permis d’obtenir une amélioration fonctionnelle significative comparable avec d’autres ostéotomies conventionnelles dites à ciel ouvert ou encore percutanées. Avec une correction en moyenne de 61 % de l’angle d’hallux valgus et une correction moyenne de 22 %, de l’angle de metatarsus varus, la technique chirurgicale miniinvasive utilisée dans notre étude est adaptée et efficace pour la correction des déformations moyennes à modérées. Les résultats radiographiques révèlent également une correction significative du DMAA garant de la congruence de l’articulation métatarsophalangienne. Nous soulignons l’importance du geste chirurgical phalangien, la satisfaction précoce des patients après chirurgie étant surtout due à l’ostéotomie de varisation-accourcissement de la première phalange par réduction de la crosse phalangienne et suppression du conflit mécanique lors du chaussage.
    Médecine et Chirurgie du Pied 12/2011; 27(4). DOI:10.1007/s10243-011-0318-8 · 0.06 Impact Factor
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