SLR - October 2017 - Ellen B. Colgan; Emily Keeter
Reference: Park, C.H. & Lee, W.C. Recurrence of Hallux Valgus Can Be Predicted from Immediate Postoperative Nonweightbearing Radiographs. J Bone Joint Surg Am. 2017; 99:1190–7.Scientific Literature Review
Reviewed By: Ellen B. Colgan, DPM; Emily Keeter, DPM
Residency Program: SSM Health DePaul Hospital, St. Louis, MO
Podiatric Relevance: This study aimed to identify risk factors for the recurrence of hallux valgus intra- and immediately postoperatively in order to allow for additional corrective procedures before the completion of surgical correction. Recurrence of hallux valgus is a common complication of hallux valgus correction and can lead to dissatisfied patients and subsequent surgical procedures. The authors hypothesized that recurrence following hallux valgus correction can be predicted by evaluation of immediate nonweightbearing postoperative radiographs.
Methods: This retrospective study reviewed 105 consecutive patients with moderate to severe hallux valgus deformity who underwent surgery by a single surgeon. A total of 93 of the patients were included in the final study results. All patients received a proximal chevron osteotomy of the first metatarsal combined with a distal soft-tissue procedure. The patients were categorized into two groups: recurrence versus nonrecurrence. Between the two groups, radiographic changes were observed in the HVA, IMA and sesamoid position at preop, immediately postop, six weeks, three months and six months and at the last follow-up visit. Full weightbearing was allowed at the seven-week postop. Wilcoxon signed-rank test was used to compare the radiographic measures at each visit.
Results: A total of 117 feet were evaluated with 20 demonstrating recurrence of hallux valgus. The mean preoperative hallux valgus angle was significantly larger in the recurrence group; however, the mean preoperative intermetatarsal angle and the sesamoid position did not differ between the recurrence and the nonrecurrence groups. The mean intermediate postoperative hallux valgus angle and the grade of sesamoid position were significantly greater in the recurrence group as compared to the nonrecurrence group, but the mean immediate postoperative intermetatarsal angle did not differ between the two groups. The authors noted that the mean preoperative metatarsus adductus angle and the immediate postoperative distal metatarsal articular angle were significantly larger in the recurrence group. The authors found that a combination of an immediate postoperative hallux valgus angle of greater than eight degrees, an immediate postoperative sesamoid position grade of four or greater, a preoperative metatarsus adductus angle of greater than 23 degrees and a preoperative hallux valgus angle greater than 40 degrees significantly correlated with recurrence of hallux valgus deformity.
Conclusion: The authors concluded that using an immediate postoperative cutoff value of eight degrees for hallux valgus angle was useful in determining likelihood of recurrence. Patients who presented with a hallux valgus angle of greater than eight degrees were 28 times more likely to have recurrence of hallux valgus deformity as compared to a value of less than eight degrees. The authors recommended the use of immediate postoperative nonweightbearing radiographs to evaluate the need for further procedures to prevent the recurrence of hallux valgus deformity.