Mid-term outcomes after proximal crescentic and distal Chevron osteotomy for hallux valgus: a retrospective single-centre study of 66 patients (73 feet)

Abstract

Background and Objective:  Radiographic alignment and validated patient-reported outcomes (PROMs) both matter for hallux valgus surgery success. We quantified mid-term outcomes of two corrective osteotomies and examined whether radiographic correction predicts patient-reported gains. Methods: Retrospective single-centre study of 66 consecutive patients (73 feet; February 2012–March 2015) undergoing proximal crescentic osteotomy plus distal soft-tissue procedure (n = 41 feet) or distal Chevron osteotomy (n = 32 feet), per an institutional severity-based algorithm with Kirschner-wire fixation. Hallux valgus angle (HVA), intermetatarsal angle (IMA), Visual Analogue Scale (VAS), AOFAS Hallux Metatarsophalangeal–Interphalangeal Scale (AOFAS-HMI) and Foot and Ankle Outcome Score (FAOS) were assessed preoperatively and at last follow-up. Results: Mean follow-up was 17.7 ± 9.9 months. HVA improved from 38.0 ± 7.8° to 24.7 ± 5.2°, IMA from 14.4 ± 3.1° to 6.6 ± 1.3°, VAS from 8.6 ± 1.2 to 1.3 ± 1.3 and, AOFAS-HMI from 49.7 ± 17.2 to 88.3 ± 8.2 (all p < 0.001). All five FAOS subscales improved (mean change +16.6 ± 21.6 to +32.7 ± 30.9 points; Cohen's d 0.78–1.26); 60.3–80.8% of feet reached the minimal clinically important difference and 53.4–86.3% a pre-specified acceptable-symptom-state threshold. ΔFAOS-Pain correlated strongly with ΔFAOS-ADL (r = 0.85, p < 0.001). Conclusions: Both techniques produced clinically meaningful improvements; patient-reported gains were not strongly determined by radiographic correction. Obtained with Kirschner-wire fixation and 4-week casting, these data provide a historical control dataset against which contemporary rigid-fixation and minimally invasive series can be audited. Level of Evidence: III, retrospective comparative study.