Patients expectations versus their functional outcomes after hallux valgus corrective surgery: a prospective study

S. Yousaf, S. Jeong, P. Hamilton, A. Sott

Purpose: To explore the relationship in terms of time scale between pre-operative expectations and postoperative outcomes and satisfaction after Hallux valgus surgery.

Methods: A patient derived questionnaire was developed and 30 patients aged 19 to 67 were included undergoing primary hallux valgus correction with a first metatarsal osteotomy and distal soft tissue release. Patients were asked pre-operatively to quantify their expected time scale for improvement in pain, ability to walk unaided, ability to drive, routine foot wear and foot feeling normal at 6 weeks, 3 and 6 months following surgery, and to indicate their confidence in achieving this result. Patients recorded postoperative outcomes achieved at number of weeks. Ordinal logistic regression multivariate modelling was used to examine predictors of postoperative satisfaction.

Results: 90% of the patients were able to walk unaided and drive before or around the expected time scale at an average of five weeks´ time. Persistent pain subsided at an average of two weeks post operatively which led to high satisfaction Although differences between patients´ expectation and achievement were minimal at 6 weeks post-operatively, there was some discrepancy at 3 months, with patient expectations far exceeding achievement. The least satisfactory outcome was normal feeling of foot at six months follow up. There were significant correlations between failure to achieve expectations and the importance patients attached to recovery.

Conclusions: This study underlines the importance of taking preoperative expectations into account to obtain an informed choice on the basis of the patient´s preferences. Patients´ pre-operative expectations of surgical outcome exceed their functional achievement but satisfaction remains high if pain control and ability to walk unaided is achieved early after hallux valgus corrective surgery.