Foot & Ankle

摘要

This article from Singapore (Singapore) gives a slightly new perspective on pain relief after hallux valgus surgery. The authors argue that, despite the large number of publications, there are few reporting on pain resolution following surgery. They designed a prospective study of patients undergoing hallux valgus surgery who were prospectively followed. Patients were treated according to the institutional preference and reconstructive surgery was chosen based upon hallux valgus angle, intermetatarsal angle and deformity of adjacent joints. The authors entered 308 patients into the study and reviewed them at both six months and two years following surgery to establish the residual pain levels. Outcomes were assessed using the visual analog scale (VAS), the AOFAS forefoot specific outcome and the 36-item short form survey (SF-36) to assess quality of life. The authors established that 31% (n = 94) of patients had residual pain at six months. Four of these went on to develop osteoarthritis, however, the picture was rosier for the remaining 90 patients, of whom 81% (n = 73) went on to improve their outcomes over the subsequent 18 months. The authors also investigated the potential predictors of poor outcomes. For patients who did not have a resolution of their pain higher pre-operative pain scores and a lower pre-operative mental component of the SF-36 were potentially predictive of ongoing pain following surgery. It is clear that, for many patients, forefoot hallux valgus surgery can be expected to improve their pre-operative pain levels, and that this improvement can be seen to span a two-year period, with outcomes improving between six and 18 months. Some patient selection is obviously required as those reporting disproportionate pre-operative pain levels and with poor performance on the SF-36 mental component score did not do as well as the other patients.