Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jun 26, 2016; 6(2): 171-180
Published online Jun 26, 2016. doi: 10.5662/wjm.v6.i2.171
Footwear modification following hallux valgus surgery: The all-or-none phenomenon
Cal Robinson, Abhijit Bhosale, Anand Pillai
Cal Robinson, Abhijit Bhosale, Anand Pillai, Orthopaedics Department, University Hospital of South Manchester, Manchester M23 9LT, United Kingdom
Cal Robinson, School of Medicine, University of Manchester, Manchester M13 9PT, United Kingdom
Author contributions: All authors listed contributed significantly to the study design and production of the final manuscript.
Institutional review board statement: The study methodology was reviewed and subsequently approved by the Clinical Audit team and Patient Experience Manager at University Hospital of South Manchester.
Informed consent statement: Verbal consent was given by all study participants prior to their inclusion. All patient identifiable information was subsequently anonymized.
Conflict-of-interest statement: No conflicts of interests to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the Dryad repository.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anand Pillai, FRCS, Orthopaedics Department, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom. aorthopod@yahoo.co.uk
Telephone: +44-0161-9987070 Fax: +44-0161-2912037
Received: July 30, 2015
Peer-review started: August 6, 2015
First decision: March 1, 2016
Revised: March 31, 2016
Accepted: April 21, 2016
Article in press: April 22, 2016
Published online: June 26, 2016
Abstract

AIM: To define footwear outcomes following hallux valgus surgery, focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection.

METHODS: Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods, with favourable reported outcomes. The return to various types of footwear post-operatively is reflective of the degree of correction achieved, and corresponds to patient satisfaction. Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms. Many female patients will additionally attempt to return to high-heeled, narrow toe box shoes. However, minimal evidence exists to guide their expectations. Sixty-five female hallux valgus patients that had undergone primary surgery between 2011 and 2013 were retrospectively identified using our hospital surgical database. Patients were reviewed using a footwear-specific outcome questionnaire at a mean 18.5 mo follow-up.

RESULTS: Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort. Of those intending to resume wearing heeled footwear, 62% were able to do so, with 77% of these patients wearing these as or more frequently than pre-operatively. No significant difference was observed between pre- and post-operative heel size. Mean time to return to heeled footwear was 21.4 wk post-operation. Cosmetic outcomes were very high and did not adversely impact footwear selection.

CONCLUSION: We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery. We observed an “all-or-none phenomenon” where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively. A minority of patients were unable to return to comfortable footwear post-operatively, which had adverse ramifications on their quality-of-life. We recommend that the importance of managing patient expectations through appropriate pre-operative counselling be emphasized in forefoot surgery.

Keywords: Hallux valgus, Bunion, Footwear, High-heels, Scarf osteotomy, Lapidus procedure

Core tip: Footwear outcomes following primary hallux valgus surgery are favourable, with the majority of patients returning to comfortable footwear post-operatively with minimal to no discomfort. An additional cohort of female patients will attempt to return to heeled footwear. Nearly two-thirds of these patients tolerated heeled footwear post-operatively, the majority of these at the same heel size and frequency of use as pre-operative levels. Appropriate pre-operative counselling is imperative to achieving high patient satisfaction with footwear outcomes following hallux valgus surgery.