Subjective versus objective assessment in early clinical outcome of modified Lapidus procedure for hallux valgus deformity

  • S. Chopra
    Correspondence
    Corresponding author at: Centre Hospitalier Universitaire Vaudois (CHUV), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland.
    Affiliations
    Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland
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  • K. Moerenhout
    Affiliations
    Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland
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  • X. Crevoisier
    Affiliations
    Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland
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      Highlights

      • Clinical and biomechanical assessment at 6 months post modified Lapidus
      • No improvement in gait mechanics at 6 months postoperatively
      • Excellent clinical scores and radiographic results at 6 months postoperatively
      • Foot and ankle ability measure score results were comparable with the gait outcome.
      • Nine gait parameters can describe gait prognosis in hallux valgus deformity.

      Abstract

      Background

      Studies have assessed the outcome of hallux valgus surgeries based on subjective questionnaires, usually the American Orthopaedic Foot and Ankle Society Score, and radiographic results reporting good to excellent outcome at 6–12 months postoperatively. However, contrasting results were reported by gait studies at 12–24 months postoperatively. In a previous study, we found nine gait parameters which can describe the altered gait in hallux valgus deformity. This study aimed, to assess the outcome of modified Lapidus at 6 months postoperatively, using gait assessment method, to determine if the nine specified gait parameters effectively relates with the clinical scores and the radiological results or add information missed by these commonly used clinical assessments.

      Method

      We assessed 21 participants including 11 controls and 10 patients with moderate to severe hallux valgus deformity. The patient group was followed 6 months postoperatively. The ambulatory gait assessment was performed utilizing pressure insoles and inertial sensors. Clinical assessment includes foot and ankle questionnaires along with radiographic results. Comparison was made using non parametric tests, P < 0.05.

      Findings

      Altered gait patterns, similar to the preoperative outcome, persisted at 6 months postoperatively when compared to controls. The foot and ankle ability measure score showed an outcome comparable to the gait results. In contrast, the American Orthopaedic Foot and Ankle Society Score and radiographic results showed significant improvement.

      Interpretation

      Study supports the reliability of nine defined gait parameters in assessing the outcome of hallux valgus surgeries. The existing clinical assessment overestimates the functional outcome at the early postoperative phase.

      Keywords

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      References

        • Adam S.P.
        • Choung S.C.
        • Gu Y.
        • O'Malley M.J.
        Outcomes after scarf osteotomy for treatment of adult hallux valgus deformity.
        Clin. Orthop. Relat. Res. 2011; 469: 854-859
        • Baumhauer J.F.
        • Nawoczenski D.A.
        • DiGiovanni B.F.
        • Wilding G.E.
        Reliability and validity of the American Orthopaedic Foot and Ankle Society Clinical Rating Scale: a pilot study for the hallux and lesser toes.
        Foot Ankle Int. 2006; 27: 1014-1019
        • Bryant A.R.
        • Tinley P.
        • Cole J.H.
        Plantar pressure and radiographic changes to the forefoot after the Austin bunionectomy.
        J. Am. Podiatr. Med. Assoc. 2005; 95: 357-365
        • Button G.
        • Pinney S.
        A meta-analysis of outcome rating scales in foot and ankle surgery: is there a valid, reliable, and responsive system?.
        Foot Ankle Int. 2004; 25: 521-525
        • Campbell R.
        • Evans M.
        • Tucker M.
        • Quilty B.
        • et al.
        Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee.
        J. Epidemiol. Community Health. 2001; 55: 132-138
        • Cancilleri F.
        • Marinozzi A.
        • Martinelli N.
        • Ippolito M.
        • et al.
        Comparison of plantar pressure, clinical, and radiographic changes of the forefoot after biplanar Austin osteotomy and triplanar Boc osteotomy in patients with mild hallux valgus.
        Foot Ankle Int. 2008; 29: 817-824
        • Canseco K.
        • Rankine L.
        • Long J.
        • Smedberg T.
        • et al.
        Motion of the multisegmental foot in hallux valgus.
        Foot Ankle Int. 2010; 31: 146-152
        • Chopra S.
        • Rouhani H.
        • Assal M.
        • Aminian K.
        • et al.
        Outcome of unilateral ankle arthrodesis and total ankle replacement in terms of bilateral gait mechanics.
        J. Orthop. Res. 2014; 32: 377-384
        • Chopra S.
        • Moerenhout K.
        • Crevoisier X.
        Characterization of gait in female patients with moderate to severe hallux valgus deformity.
        Clin. Biomech. 2015; 30: 629-635
        • Coetzee J.C.
        • Wickum D.
        The Lapidus procedure: a prospective cohort outcome study.
        Foot Ankle Int. 2004; 25: 526-531
        • Coutts F.
        Gait analysis in the therapeutic environment.
        Man. Ther. 1999; 4: 2-10
        • Dennis N.Z.
        • Das De S.
        Modified Mitchell's osteotomy for moderate to severe hallux valgus—an outcome study.
        J. Foot Ankle Surg. 2011; 50: 50-54
        • Deschamps K.
        • Birch I.
        • Desloovere K.
        • Matricali G.A.
        The impact of hallux valgus on foot kinematics: a cross-sectional, comparative study.
        Gait Posture. 2010; 32: 102-106
        • Dhukaram V.
        • Hullin M.G.
        • Senthil Kumar C.
        The Mitchell and Scarf osteotomies for hallux valgus correction: a retrospective, comparative analysis using plantar pressures.
        J. Foot Ankle Surg. 2006; 45: 400-409
        • Galica A.M.
        • Hagedorn T.J.
        • Dufour A.B.
        • Riskowski J.L.
        • et al.
        Hallux valgus and plantar pressure loading: the Framingham foot study.
        J. Foot Ankle Res. 2013; 6: 42
        • Garrido I.M.
        • Rubio E.R.
        • Bosch M.N.
        • Gonzalez M.S.
        • et al.
        Scarf and Akin osteotomies for moderate and severe hallux valgus: clinical and radiographic results.
        Foot Ankle Surg. 2008; 14: 194-203
        • Guyton G.P.
        Theoretical limitations of the AOFAS scoring systems: an analysis using Monte Carlo modeling.
        Foot Ankle Int. 2001; 22: 779-787
        • Hunt K.J.
        • Hurwit D.
        Use of patient-reported outcome measures in foot and ankle research.
        J. Bone Joint Surg. Am. 2013; 95 (111-119): e118
        • Kerr H.L.
        • Jackson R.
        • Kothari P.
        Scarf–Akin osteotomy correction for hallux valgus: short-term results from a district general hospital.
        J. Foot Ankle Surg. 2010; 49: 16-19
        • Khazzam M.
        • Long J.T.
        • Marks R.M.
        • Harris G.F.
        Kinematic changes of the foot and ankle in patients with systemic rheumatoid arthritis and forefoot deformity.
        J. Orthop. Res. 2007; 25: 319-329
        • Kopp F.J.
        • Patel M.M.
        • Levine D.S.
        • Deland J.T.
        The modified Lapidus procedure for hallux valgus: a clinical and radiographic analysis.
        Foot Ankle Int. 2005; 26: 913-917
        • Lambrecht J.
        • Kirsch R.
        Miniature low-power inertial sensors: promising technology for implantable motion capture systems.
        IEEE Trans. Neural Syst. Rehabil. Eng. 2014; 22: 1138-1147
        • Lapidus P.W.
        Operative correction of the metatarsus varus primus in hallux valgus.
        Surg. Gynecol. Obstet. 1934; 58: 183
        • Lin J.S.
        • Bustillo J.
        Surgical treatment of hallux valgus: a review.
        Curr. Opin. Orthop. 2007; 18: 112-117
        • Mariani B.
        • Rouhani H.
        • Crevoisier X.
        • Aminian K.
        Quantitative estimation of foot-flat and stance phase of gait using foot-worn inertial sensors.
        Gait Posture. 2013; 37: 229-234
        • Nix S.
        • Smith M.
        • Vicenzino B.
        Prevalence of hallux valgus in the general population: a systematic review and meta-analysis.
        J. Foot Ankle Res. 2010; 3: 21
        • Parker J.
        • Nester C.J.
        • Long A.F.
        • Barrie J.
        The problem with measuring patient perceptions of outcome with existing outcome measures in foot and ankle surgery.
        Foot Ankle Int. 2003; 24: 56-60
        • Razak A.H.
        • Zayegh A.
        • Begg R.K.
        • Wahab Y.
        Foot plantar pressure measurement system: a review.
        Sensors (Basel). 2012; 12: 9884-9912
        • Robinson A.H.
        • Limbers J.P.
        Modern concepts in the treatment of hallux valgus.
        J. Bone Joint Surg. (Br.). 2005; 87: 1038-1045
        • Rouhani H.
        • Crevoisier X.
        • Favre J.
        • Aminian K.
        Outcome evaluation of ankle osteoarthritis treatments: plantar pressure analysis during relatively long-distance walking.
        Clin. Biomech. 2011; 26: 397-404
        • Rouhani H.
        • Favre J.
        • Crevoisier X.
        • Aminian K.
        Ambulatory measurement of ankle kinetics for clinical applications.
        J. Biomech. 2011; 44: 2712-2718
        • Rouhani H.
        • Favre J.
        • Crevoisier X.
        • Aminian K.
        Measurement of multi-segment foot joint angles during gait using a wearable system.
        J. Biomech. Eng. 2012; 134: 061006
        • Saro C.
        • Andrén B.
        • Felländer-Tsai L.
        • Lindgren U.
        • et al.
        Plantar pressure distribution and pain after distal osteotomy for hallux valgus: a prospective study of 22 patients with 12-month follow-up.
        Foot. 2007; 17: 84-93
        • Schuh R.
        • Hofstaetter S.G.
        • Kristen K.H.
        • Trnka H.J.
        Effect of physiotherapy on the functional improvement after hallux valgus surgery — a prospective pedobarographic study.
        Z. Orthop. Unfall. 2008; 146: 630-635
        • Schuh R.
        • Hofstaetter S.G.
        • Adams Jr., S.B.
        • Pichler F.
        • et al.
        Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the first ray during the stance phase.
        Phys. Ther. 2009; 89: 934-945
        • Schuh R.
        • Adams S.
        • Hofstaetter S.G.
        • Krismer M.
        • et al.
        Plantar loading after chevron osteotomy combined with postoperative physical therapy.
        Foot Ankle Int. 2010; 31: 980-986
        • SooHoo N.F.
        • Shuler M.
        • Fleming L.L.
        • American Orthopaedic F
        • et al.
        Evaluation of the validity of the AOFAS Clinical Rating Systems by correlation to the SF-36.
        Foot Ankle Int. 2003; 24: 50-55
        • Turner D.E.
        • Woodburn J.
        • Helliwell P.S.
        • Cornwall M.W.
        • et al.
        Pes planovalgus in RA: a descriptive and analytical study of foot function determined by gait analysis.
        Musculoskeletal Care. 2003; 1: 21-33
        • Wen J.
        • Ding Q.
        • Yu Z.
        • Sun W.
        • et al.
        Adaptive changes of foot pressure in hallux valgus patients.
        Gait Posture. 2012; 36: 344-349