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Patient acceptable symptom state for European Foot and Ankle Society Score After Hallux Valgus Surgery
Hong Jing Lee1, Khye Soon Andy Yew1, William Yeo1
1Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
Background:
The European Foot & Ankle Society (EFAS) Score is a validated patient-reported outcome measure for the evaluation of postoperative foot and ankle outcomes. Yet, unlike the AOFAS, there is a dearth of literature defining the patient acceptable symptom state (PASS) for EFAS after hallux valgus surgery. This study aimed to determine the PASS for EFAS after hallux valgus surgery.
Methods:
This was a retrospective cohort study using prospectively collected data of patients who underwent hallux valgus surgery between May 2017 and September 2023 in the authors' institution. Patients were evaluated preoperatively and at 6 months and 2 years postoperatively, using functional outcomes such as EFAS and American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Rating System. PASS thresholds were determined with the Youden Index on receiver operating characteristic curves, with responses to an anchor question as the external criterion.
Results:
A total of 361 patients were followed up for 2 years. This included 324 (89.8%) female and 37 (10.2%) male patients. The mean age and body mass index (BMI) was 56.0 ± 14.0 years and 24.1 ± 4.6, respectively. Patients underwent various procedures including scarf-Akin osteotomy (n = 220, 60.9%), minimally invasive chevron-Akin osteotomy (n = 102, 28.3%), arthrodesis of first metatarsophalangeal joint (n = 15, 4.2%), scarf osteotomy (n = 14, 3.9%), Lapidus procedure (n = 7, 1.9%), and Bosch osteotomy (n = 3, 0.8%). The PASS for EFAS was determined to be 20.5 at 6 months (sensitivity 86.8%, specificity 70.4%) and 23.5 at 2 years (sensitivity 87.2%, specificity 72.0%). However, the PASS for AOFAS was determined to be 84.5 at 6 months (sensitivity 72.6%, specificity 75.0%) and 82.5 at 2 years (sensitivity 90.9%, specificity 63.4%).
Conclusion:
The PASS for EFAS established in this study can be used for the clinical interpretation of future hallux valgus studies. A potential ceiling effect of the EFAS was identified, and the revised AOFAS PASS thresholds may warrant consideration.
