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

Abstract

BackgroundStudies 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 6–12months postoperatively. However, contrasting results were reported by gait studies at 12–24months 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 6months 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. MethodWe assessed 21 participants including 11 controls and 10 patients with moderate to severe hallux valgus deformity. The patient group was followed 6months 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. FindingsAltered gait patterns, similar to the preoperative outcome, persisted at 6months 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. InterpretationStudy 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.