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Jae Wan Suh, Sung Hyun Kim*, Hyun-Woo Park
Abstract
Purpose
This study investigated the recurrence rate after performing hallux valgus correction using scarf and Akin osteotomy, and also identified the correlation and cut-off values of both the preoperative and postoperative radiographic parameters as risk factors for the recurrence of hallux valgus.
Materials and Methods
We reviewed 87 hallux valgus patients (122 feet) who received scarf and Akin osteotomy from January 2007 to August 2015. The clinical outcomes were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The radiological outcome measures included the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) as determined on the serial weight bearing radiographs. Recurrence was defined as more than 20 degrees of HVA noted on the final follow-up radiograph. Those radiological factors associated with recurrence were evaluated and analyzed.
Results
The mean follow-up duration was 20.6 months (12.0∼46.5 months) and the mean age was 44 years (13∼80 years). The VAS and AOFAS scores were significantly improved at the time of the final follow-up (7.0 to 2.0, p<0.001; 78.0 to 92.0, p<0.001; respectively). Significant corrections in the HVA, IMA, and DMAA were obtained (p<0.001). Eleven (9.0%: 11/122) cases experienced recurrent hallux valgus deformity. The postoperative IMA, DMAA and HVA showed significant moderate to strong correlation with HVA at the final follow-up (Pearson correlation coefficient: 0.44, 0.70, and 0.88, respectively; p<0.001). Postoperative HVA>16.7 degrees, postoperative DMAA>13.9 degrees, and postoperative IMA>8.2 degrees showed statistically significant correlation with radiological recurrence at the last follow-up, and the odds ratio of each variable was high in order.
Conclusion
Our radiographic results indicated that postoperative HVA>16.7 degrees, postoperative DMAA>13.9 degrees, and postoperative IMA>8.2 degrees can be risk factors for hallux valgus recurrence. These risk factors may be helpful for modifying surgical procedures and preventing the recurrence of hallux valgus.
Figures and Tables
Figure 1
Receiver operating characteristic (ROC) curve of radiographic risk factors of hallux valgus recurrence after hallux valgus surgery. (A) Preoperative radiographic variables, (B) postoperative radiographic variables. IMA: intermetatarsal angle, HVA: hallux valgus angle, DMAA: distal metatarsal articular angle.
Figure 2
Standing anteroposterior radiographs of recurrent hallux valgus case in a 15-year-old female foot shows (A) preoperative, (B) postoperative 2 months, and (C) postoperative 3 years follow-up. Hallux valgus angle (HVA) and intermetatarsal angle (IMA) well corrected. However, postoperative distal metatarsal articular angle (DMAA) was 13.9 degree. At last follow-up, hallux valgus recurred with HVA 28.2 degrees.
Figure 3
Standing anteroposterior radiographs of no recurrent hallux valgus case in a 19-year-old female foot shows (A) preoperative, (B) postoperative 2 months, and (C) postoperative 2 years follow-up. Hallux valgus angle (HVA) and intermetatarsal angle (IMA) well corrected. Postoperative distal metatarsal articular angle (DMAA) was 7.1 degree. At last follow-up, the foot showed no recurrence with HVA 10 degrees.
Notes
References
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