Comparison of the outcomes of current surgical algorithms in hallux valgus

Background: The management of hallux valgus (HV) still lacks standardization and few therapeutic algorithms have been published. The aim of this study was to compare the radiological outcomes of current algorithms in patients who underwent surgical treatment for isolated HV. A clearer understanding of the effectiveness of surgical treatment of HV may be of interest to patients, clinicians, researchers and policy makers in the orthopedic field. Methods: A retrospective study was conducted on 120 consecutive patients treated between February 2013 and September 2021 with different surgical techniques: Akin osteotomy, Scarf osteotomy, Reverdin-Green osteotomy, Lapidus procedure, metatarsophalangeal arthrodesis. The radiological angles, including the HV angle (HVA), intermetatarsal angle (IMA), hallux valgus interphalangeal angle (HVI), and distal metatarsal articular angle (DMAA), sesamoid position and articular congruence were evaluated. Radiographic measurements were performed pre-and postoperatively at one-month follow-up. Patients were also retrospectively categorized based on whether their pre-operative condition and performed surgery matched the criteria of each algorithm: Group A for the American Orthopedic Foot & Ankle Society (AOFAS) algorithm, Group B for the algorithm proposed by Fraissler et al., and Group C for the Chinese Consensus algorithm. Results: The final sample consisted of 113 cases. All the postoperative HVA, IMA, HVI, and DMAA values significantly improved compared to preoperative values (all P<0.001). The severity of HV significantly decreased in all of the analyzed groups (P<0.001). Joint congruency improved after surgery (P<0.001). Preoperatively, the sesamoid position was graded as 3 in 63% of the cases, while postoperatively, most patients were graded as 0 or 1 (73%). Conclusions: Satisfactory radiological results can be expected in patients who have undergone surgical treatment for isolated HV. Even though treatment algorithms proposed in literature showed different designs and factors to consider, radiographic improvements were noted in all groups analyzed.