What outcomes matter to patients having surgical treatment for symptomatic hallux valgus? : a systematic review of qualitative studies.

AIMS: Hallux valgus (HV) is a common deformity of the foot, for which various forms of surgical treatment are available. A recent think tank highlighted a lack of understanding about which key outcomes matter most to patients who undergo surgery for HV. The aim of this systematic review was to synthesize the existing evidence to establish whether commonly used outcome measures in foot and ankle surgery adequately reflect what is important to patients.

METHODS

We conducted a systematic review of qualitative studies in which methods such as patients' interviews, questionnaires, or focus groups were used to understand which outcomes are important to adults undergoing surgery for HV. The following databases were searched: CINAHL (Cumulative Index to Nursing and Allied Health Literature), PubMed, MEDLINE, Embase, Emcare, and Cochrane Library, in addition to the reference lists of the studies which were included. The review was prospectively registered with the PROSPERO database and conducted following PRISMA guidelines.

RESULTS

Ten studies were included. The four most common themes which were identified as being important to patients were improvements in pain over the hallux, footwear restrictions, restrictions in daily activities and the function of the foot, and cosmesis.

CONCLUSION

The Manchester-Oxford Foot Questionnaire was found to be the only outcome measure which specifically addresses these themes, while also including questions about the psychosocial impact. Cosmesis is under-represented in the outcome measures. Further research is needed to explore the psychosocial factors which are important to patients so that they can be included within the measures which are used to assess outcome after the surgical treatment for HV.