Low Symptom Burden, Limited Gain: Preoperative MOxFQ Predicts Outcome After Chevron Osteotomy

Radiographic correction after hallux valgus surgery does not necessarily translate into clinically meaningful improvement. The ability of preoperative patient-reported outcome measures (PROMs) to predict clinically meaningful improvement after hallux valgus surgery remains unclear.

In this prospective cohort study, 193 patients undergoing Chevron osteotomy were included. Clinically meaningful improvement in the Manchester-Oxford Foot Questionnaire (MOxFQ) score at 1 year was defined as a ≥15-point improvement. A mixed effects model was used as the primary longitudinal analysis to assess change over time, whereas logistic regression and receiver operating characteristic (ROC) analysis evaluated clinically meaningful improvement and predictive performance.

A total of 139 patients (72%) achieved clinically meaningful improvement. Patients with higher preoperative MOxFQ Index scores were more likely to benefit, whereas those with lower scores showed limited improvement. Preoperative MOxFQ score independently predicted responder status (odds ratio 1.06 per point; P < .001). ROC analysis demonstrated moderate discrimination (area under the curve 0.70), with a threshold of approximately 42 yielding 71% sensitivity and 65% specificity.

Preoperative MOxFQ Index score predicts clinically meaningful improvement following Chevron osteotomy. Patients with a higher symptom burden benefit the most, whereas those with low baseline scores have limited potential for meaningful gain. A threshold of approximately 42 may help identify patients most likely to benefit from surgery.

Level IV, prospective case series.