Foot Width Changes Following Hallux Valgus Surgery

Introduction: Hallux valgus is one of the most common deformities of the adult foot, and can adversely affect quality of life, with common complaints including pain, footwear restrictions and cosmesis.

Every clinician is familiar with the patients’ concerns regarding the postoperative foot appearance and footwear anticipations. Surprisingly, although patients are concerned with postoperative foot width, there are only scarce reports on this issue. This study was undertaken to evaluate the impact of hallux valgus correction on foot width.

Materials and Methods: The study included 71 feet with moderate to severe hallux valgus treated with Scarf osteotomy, between January 2009 to June 2016. Patients were included only if pre- and postoperative weightbearing X-rays at final followup were available.

The average age was 55.7 years (range, 20 to 76), with average follow-up of 20.7 months (range, 6 to 96).

Patients’ radiographic records were studied to evaluate postoperative change in hallux valgus angle (HVA), intermetatarsal angle (IMA) and foot width (assessed by measuring bone (BW) and soft tissue maximal width (STW).

Results: Following surgery deformity was corrected with preoperative mean HVA of 35.82° and IMA of 14.05° compared to postoperative mean of 13.67° and 6.91°, respectively.

Specifically assessing foot width changes, data analysis showed: Mean bone width change ratio was 0.95 (SD=0.1), mean soft tissue width change ratio was 0.98 (SD=0.1). The study cohort could be divided to patients with increase of more than 5% bone width (13 feet;18.3%), no change (+/-5%) bone width (26 feet; 36.6%) and more than 5% bone width decrease (32 feet; 45.1%). Soft tissue width data showed similar division. The correlation between bone and soft tissue width was 0.933 (p <0.0001).

Conclusion: This study shows that postoperative foot width both bony and soft tissue decreases or does not change in 4 out of 5 patients. However, there are cases in which foot width actually increases.