Efficacy of Bilateral Simultaneous Hallux Valgus Correction in the Elderly Aged 70 to 79 Compared to Middle Age

Abstract

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:Due to the increase in life expectancy, the frequency of elderly patients with moderate to severe hallux valgus deformity is expected to increase. The aim of this study was to evaluate the clinical and radiological efficacy of bilateral simultaneous correction of hallux valgus in elderly patients aged 70s and to compare the results with those of middle age.Methods:From August 2014 to July 2017, 92 women (184 feet) patients, who underwent bilateral simultaneous correction surgery (proximal chevron metatarsal osteotomy, Akin osteotomy, and distal soft tissue procedure) due to moderate to severe hallux valgus deformity, were retrospectively analyzed. Based on the age at the time of surgery, elderly patients in their 70’s (70˜79 years) were defined as the ‘elderly’ group and middle aged patients in the 45˜50 years as the ‘middle age’ group. The VAS score, AOFAS-Hallux Metatarsophalangeal-Interphalangeal score, hallux valgus angle, 1-2 intermetatarsal angle, and post-operative complications were compared and analyzed between the two groups. The mean follow-up period was 30.6(24˜57) months. There was no significant difference in improvement of VAS scores after surgery between the middle age and elderly group (p=0.710).Results:Although the final AOFAS scores were significantly different between two groups, there was no significant difference in AOFAS score improvement after surgery between two groups (p=0.129) (Table 1). At the last follow up after surgery, the HV angles and 1-2 IM angles were all significantly improved compared to the preoperation (Table2). Complications occurred in 16 cases, 5 in middle age (11.1%) and 9 in the elderly (19.1%). In the middle age group, 1 case (2.2%) of HV recurrence (> 15 degrees), 1 case of medial incision site paresthesia, 2 plantar pain, and 1 MTP joint stiffness occurred. In the elderly group, 3 case (6.4%) HV recurrence, 2 cased of displacement after metatarsal bone fixation, 2 cases of medial incision site paresthesia, and 2 plantar pain.Conclusion:In patients aged 70s, bilateral simultaneous correction of moderate to severe hallux valgus showed good improvement of clinical and radiologic outcome without any significant difference compared to the middle age group. However, the attention should be paid to the fixation failure after correction in the simultaneous treatment of hallux valgus in elderly patients aged 70s.