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Comparison of radiological improvement in hallux valgus toe deformity after different corrective surgeries and its correlation with patient satisfaction score

Abstract Background: Hallux valgus is the end result of an unstable first ray (or medial column) of the foot. Over 130 surgical techniques have been described for its management. A surgeon treating hallux valgus must have a decision-making strategy to optimize surgical outcome. Comparison of various techniques is crucial, and tools used for evaluation of the outcome of surgery should be correctly selected to improve clinical practice. Aims: In our study, we compared five different surgical techniques. Also we studied whether there is there a correlation between the degree of angular correction and patient satisfaction score. This was to determine if the commonly held view that correction of deformity on X-ray after surgery can be used as a tool to gauge the success of surgery. Patients and methods: Between April 2002 and September 2006, 137 patients (153 feet) with mild-to-severe hallux valgus deformity underwent corrective surgery. Operations included in our study were basal osteotomy, distal Chevron's, Mitchell's, Wilson's and Scarfe osteotomies. Two observers recorded angular measurements. We measured inter-metatarsal, hallux valgus and distal metatarsal articular angle. Joint congruency was also noted in the radiological assessment. Patient satisfaction was graded according to the Foot and Ankle Outcome Score (FAOS). Results: Using a paired t-test, the intra-observer differences were compared for each method and for each surgeon. It was found that there is no evidence of a significant difference in angular measurements (P < 0.005). For inter-observer measurements, we found that there is a difference for one of the angles (HVA; 95% CI). Using the Mann–Whitney test, we compared the median angular improvement for the various techniques and found that basal technique median angular improvement is better than others and also that the Wilson technique median angular improvement is lowest in the group. Using the Pearson's correlation coefficient it was found that at a 5% significance level there is no correlation between the clinical improvement and the angular improvement (P > 0.05; n = 41).