Outcomes following Surgical Intervention for Hallux Varus deformity: A Systematic Review

Abstract

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates following surgical intervention for hallux varus deformity. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for hallux varus deformity. Data regarding study characteristics, patient demographics, osteoarthritis severity, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed. Results: Twelve studies were included. In total, 168 patients (186 feet) underwent surgical intervention for hallux varus deformity. at a weighted mean follow-up of 49.6±36.6 months. The weighted mean AOFAS score improved from a pre-operative score of 60.5±18.4 to a post-operative score of 83.9±9.0. The weighted mean hallux valgus angle improved from a pre-operative angle of 16.9±6.5° of varus to a post-operative angle of 5.9±6.6° of valgus. The weighted mean inter-metatarsal angle improved from a pre- operative angle of 12.7±10.0° to a post-operative angle of 7.7±3.4°. The complication rate was 21.5%, the most common of which was 1st MTPJ joint pain and stiffness. Eleven failures (5.9%) were observed at a mean time of 25.0 months following the index procedure. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes together with a low failure rate following surgical intervention for hallux varus deformity at mid-term follow-up. A high complication rate was recorded. However, the marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions. Further research with a longer follow-up is warranted to determine the optimal surgical technique for hallux varus deformity correction.