title: Surgical management of hallux valgus and hallux rigidus: an email survey among Swiss orthopaedic surgeons regarding their current practice.
abstract: BACKGROUND
  Various clinical and radiological criteria have been suggested to choose one of the numerous techniques in surgical treatment of hallux valgus and rigidus. We hypothesized that the surgeons' professional background will influence that choice depending on specialization, age, type and institution of training as well as his orthopaedic cultural orientation. Since Switzerland is characterized by regional languages (the most important being German and French), we were interested to learn if the linguistic differences had an influence on the orientation of the surgeons towards e.g. Anglo-American or French surgical traditions and/or sources of literature on the subject.
  
  
  METHODS
  A survey was e-mailed to all members of the Swiss Orthopaedic Society (SGOT-SSOT). Questions were asked regarding respondents' demographics as well as their preferred treatment for 3 separate cases of (1) moderate and (2) severe hallux valgus and (3) hallux rigidus. The responses were collected and statistically analyzed.
  
  
  RESULTS
  Two hundred thirty of 322 respondents completed the survey(response rate 46 %). as they perform foot surgery on a regular base; 39 % were members of the Swiss Orthopaedic Foot and Ankle Society (SFAS). Selected surgical treatments differed as follows: in joint sparing procedures older and busier surgeons were more likely to use Chevron osteotomies, however more than 50 % preferred a Scarf-type of osteotomy. Along the so-called "Rösti-Graben" separating the French from the German speaking part of Switzerland no significant difference was found in the choice of operation technique. Nevertheless the fact being a member of SFAS showed significant differences in technical choice in case 2 and 3.
  
  
  CONCLUSIONS
  There are significant associations between the surgeons' age, expertise and training and their preferred operative intervention. Considerable differences in the surgical management were found in the practice of the general orthopaedic surgeons 72 and the foot and ankle specialists. The cultural background and training is not mirroring the classical Swiss east west discrepancy. Despite the large number of surgical options available for hallux valgus, only a small number were preferred by the majority of surgeons.
authors.affiliation: Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, CH-3041, Basel, Switzerland. lukas.iselin@usb.ch.
authors.forename: Lukas Daniel
authors.initials: LD
authors.lastname: Iselin
authors.affiliation: Department of Orthopaedics and Traumatology, Kantonsspital Luzern, Switzerland. Georg.klammer@luks.ch.
authors.forename: Georg
authors.initials: G
authors.lastname: Klammer
authors.affiliation: FussInstitut Zürich, Zürich, Switzerland. info@fussinstitut.ch.
authors.forename: Norman
authors.initials: N
authors.lastname: Espinoza
authors.affiliation: First Orthopaedic Department, Aristotle, University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece. p.symeonidis@gmail.com.
authors.forename: Panagiotis D
authors.initials: PD
authors.lastname: Symeonidis
authors.affiliation: KOF Konjunkturforschungsstelle, ETH Zürich, Zürich, Switzerland. iselin@kof.ethz.ch.
authors.forename: David
authors.initials: D
authors.lastname: Iselin
authors.affiliation: Adelaide Orthosports Clinic, Adelaide, SA, Australia. PStavrou@adelosc.com.au.
authors.forename: Peter
authors.initials: P
authors.lastname: Stavrou
mesh_terms: D000328:Adult; D000368:Aged; D020859:Hallux Rigidus / Q000601:surgery*; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013557:Switzerland