FORFoot: Forefoot offloading shoes vs rigid flat shoes in patients undergoing surgery of the first ray: A randomised controlled trial of clinical and radiological outcomes

P. Dearden, R. Ray, P. Robinson, R. Varrall, T. Goff, K. Fogarty, A. Wines

Background: It is common for patients undergoing hallux rigidus or hallux valgus surgery to be prescribed six weeks of postoperative immobilisation using either flat or reverse camber postoperative shoes. Currently, evidence is lacking to demonstrate if there is a difference between these two forms of immobilisation in either patient satisfaction or clinical outcomes.

Methods: One hundred consecutive patients undergoing Scarf/Akin osteotomies or 1^st MTPJ arthrodesis were recruited. Patients were randomised to either flat or reverse camber postoperative shoes, fifty patients in each group. Patients undergoing ancillary procedures on lesser toes were not excluded. Satisfaction with each form of postoperative shoe was reviewed by patient reported VAS pain scale and Likert satisfaction survey. Radiographic outcomes were reviewed at 1-year observing differences in fusion rates (Arthrodesis) or deformity recurrence (Hallux valgus).

Results: At completion of the study there were 47 patients in the reverse cam and 43 in the flat shoe group. No difference in primary forefoot operation, additional operation, age at surgery or pre-op VAS pain score was seen between groups. At the 6 week follow up there was no difference in post op VAS pain score between the groups. However, the flat shoe group were significantly more likely to be satisfied with their general mobility in the shoe (86.0% vs 61.7%, p=0.01) and satisfied with their stability in the shoe (90.7% vs 69.6%, p=0.03) than the reverse cam shoe group. There was no statistically significant difference seen between groups for non-union or hallux valgus recurrence rates.

Conclusions: Both forms of postoperative footwear were effective in enabling patients to mobilise and in preventing adverse outcomes. Patients are more likely to be satisfied with a flat postoperative shoe due to improved stability and ease in mobilising. The results of this study aid surgeon decision making for postoperative footwear type in forefoot surgery.