SLR - October 2019 - Ketan Mehta

A Comparison of Two Designs of Postoperative Shoe on Function, Satisfaction, and Back Pain After Hallux Valgus Surgery

Reference: Patel S, Garg P, Fazal MA, Shahid MS, Park DH, Ray PS. A Comparison of Two Designs of Postoperative Shoe on Function, Satisfaction, and Back Pain After Hallux Valgus Surgery. Foot Ankle Spec. 2019 Jun;12(3):228-232

Scientific Literature Review

Reviewed By: Ketan Mehta, DPM
Residency Program: Palmetto General Hospital – Hialeah, FL

Podiatric Relevance: The reverse camber shoe is frequently utilized by podiatric and orthopedic surgeons after a patient has undergone hallux valgus corrective surgery in an attempt to offload the forefoot, but has been associated with contributing to back pain and poor patient compliance. The goal of this prospective study was to determine if a noncambered shoe with transitional rigidity could reduce footwear related back pain and increase patient satisfaction and compliance without compromising post-operative outcomes.

Methods: This was a level II prospective comparative study in which patients older than 18 years old who had undergone a scarf osteotomy for hallux valgus deformity from a single foot and ankle surgeon were identified. A total cohort of 80 feet in 78 patients was identified with no statistical difference in the demographics between the patients and any patient with a history of midfoot, hindfoot, ankle surgeries or preexisting back pain were excluded.

Postoperative care was standardized for all patients and all patients were placed in a post-operative shoe in which full-wearing bearing was permitted. Forty patients were given the reverse camber shoe (RCS) and 40 patients were given the transitional rigidity shoe (TRS) to ambulate in. Clinical assessment was taken with Manchester-Oxford Foot Questionnaire (MOXFQ) pre-operatively, Two and six weeks post-operatively, patients were given a five-question survey on the footwear used, and radiographic assessment was undertaken by two observers to evaluate for loss of correction.

Results: There was no statistical difference observed in shoe satisfaction or MOXFQ score between the RCS and TRS groups at either two or six weeks post-operatively. Both groups experienced improvements in shoe satisfaction score between weeks two and six. Six patients in the RCS group experienced back pain in the first six weeks after surgery while no patients in the TRS group experienced back pain. Five patients in group RCS stopped using their prescribed shoes in the first six weeks due to cited back pain and difficulty with ambulation. No patients in the TRS group stopped using their prescribed shoes.

Conclusions: The study compared the outcomes of two different shoe designs after a scarf osteotomy was performed and demonstrated the TRS had similar patient satisfaction and joint specific functional outcome compared to the RCS, but the incidence of back pain was reduced in the TRS group. The authors cite several comparative studies that demonstrate similar findings with patient compliance and back pain related to the RCS. Consideration should be given to the type of post-operative shoe being dispensed to the patient and that also takes into account the type of hallux valgus corrective surgery which was performed. Future studies should focus on different hallux valgus procedures and more closely focus on assessing loss of correction. 

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