X-rays Immediately after Hallux Valgus Surgery Predict Risk of Recurrence
For patients undergoing surgery to repair hallux valgus, non-weight-bearing x-rays taken immediately after surgery can provide a good estimate of the risk that the deformity will return over time, reports a study in the current issue of The Journal of Bone & Joint Surgery.
Recurrence of hallux valgus can be “reliably predicted” from a few simple measurements on postoperative x-rays, according to research investigators Chul Hyun Park, MD, PhD, of Yeungnam University Medical Center, and Woo-Chun Lee, MD, PhD, of Injie University Seoul Paik Hospital.
In addition, they believe that with further study, using the same x-ray predictors during surgery could help to minimize recurrence risk, which has been reported to occur in up to 25% of patients who underwent hallux valgus surgery.
The study included 93 patients (117 feet) undergoing hallux valgus surgery. All but 2 patients were women, reflecting the fact that hallux valgus is commonly caused by tight, confining shoes.
At an average follow-up of 2 years, the hallux valgus recurrence rate was 17%. Recurrence was defined as a hallux valgus angle (HVA) of 20° or more.
Patients with larger preoperative and postoperative HVAs were at higher risk of recurrence. Recurrence was 28 times more likely when the postoperative HVA was 8° or more than when the HVA was less than 8°. The HVA continued to widen over time in patients with recurrent hallux valgus, but stabilized at 6 months in those without recurrence.
Although previous studies have focused on 1 or 2 risk factors for recurrent hallux valgus, the new study evaluated the effects of multiple factors. Other factors associated with increased recurrence risk included severe hallux valgus with a preoperative HVA of 40° or more and the position of the sesamoids under the joint on postoperative x rays.
If future studies confirm their results, Dr. Park and Dr. Lee believe that radiographs taken during surgery might help develop guidelines for “satisfactory correction” of hallux valgus – in particular, ensuring that surgery corrects the HVA to 8° or less.
Park CH, Lee WC. Recurrence of hallux valgus can be predicted from immediate postoperative non-weight-bearing radiographs. J Bone Joint Surg Am. 2017 Jul 19;99(14):1190-1197. doi: 10.2106/JBJS.16.00980.