title: Footwear modification following hallux valgus surgery: The all-or-none phenomenon.
abstract: OBJECTIVE
  To define footwear outcomes following hallux valgus surgery, focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection.
  
  
  METHODS
  Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods, with favourable reported outcomes. The return to various types of footwear post-operatively is reflective of the degree of correction achieved, and corresponds to patient satisfaction. Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms. Many female patients will additionally attempt to return to high-heeled, narrow toe box shoes. However, minimal evidence exists to guide their expectations. Sixty-five female hallux valgus patients that had undergone primary surgery between 2011 and 2013 were retrospectively identified using our hospital surgical database. Patients were reviewed using a footwear-specific outcome questionnaire at a mean 18.5 mo follow-up.
  
  
  RESULTS
  Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort. Of those intending to resume wearing heeled footwear, 62% were able to do so, with 77% of these patients wearing these as or more frequently than pre-operatively. No significant difference was observed between pre- and post-operative heel size. Mean time to return to heeled footwear was 21.4 wk post-operation. Cosmetic outcomes were very high and did not adversely impact footwear selection.
  
  
  CONCLUSIONS
  We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery. We observed an "all-or-none phenomenon" where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively. A minority of patients were unable to return to comfortable footwear post-operatively, which had adverse ramifications on their quality-of-life. We recommend that the importance of managing patient expectations through appropriate pre-operative counselling be emphasized in forefoot surgery.
authors.affiliation: Cal Robinson, Abhijit Bhosale, Anand Pillai, Orthopaedics Department, University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Cal
authors.initials: C
authors.lastname: Robinson
authors.affiliation: Cal Robinson, Abhijit Bhosale, Anand Pillai, Orthopaedics Department, University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Bhosale
authors.affiliation: Cal Robinson, Abhijit Bhosale, Anand Pillai, Orthopaedics Department, University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Anand
authors.initials: A
authors.lastname: Pillai
keywords: Bunion; Footwear; Hallux valgus; High-heels; Lapidus procedure; Scarf osteotomy