Torkki M, Malmivaara A, Seitsalo S, Hoikka V, Paavolainen P; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2000; 16: 426.

Jorvi Hospital, Department of Orthopaedics, Turuntie 150, Fin-02710 Espoo, Finland

Background: Although surgery and orthoses are widely used to treat hallux valgus, their effectiveness has not been rigorously evaluated. Methods: We assigned randomly 209 patients with painful hallux valgus into three treatment regimens: surgery (Chevron osteotomy), individually adjusted orthosis, or waiting list for one year. Outcomes were assessed after 6 and 12 months. The principal outcome measure was pain intensity during walking (visual analogue scale 0 to 100). Results: Compliance for the three treatment regimens was good. At six months, the pain intensity had remained similar in the control group, but decreased in the surgery and orthosis groups: adjusted mean differences in comparison with the control group were -21.6 and -14.4, respectively (p<0.05). At one year follow-up the pain intensity had decreased significantly more in the surgery than in the control group (mean difference -25,6; p<0.05); and the number of painful days was significantly less in the surgery than in the other groups. Operated patients reported both at 6 and 12 months follow-up significantly less problems with fitting footwear and at 12 months follow-up, cosmetic bothersomeness was the least in those operated. At one year follow-up patients' global assessment of improvement was 87, 43 and 23 percent in the surgery, orthosis and control groups, respectively; mean difference between surgery and control group 64 percent. Percentages satisfied for the treatment were 80, 68 and 59, respectively (p<0.05 between surgery and control groups). The total costs for the HMO were highest in the operative treatment group. The employed patients spent on an average 44 days on sick leave after the surgery. Conclusions: Surgical osteotomy for painful hallux valgus is an effective treatment, which provides also cosmetic advantages for the patients. Complications are rare. Individually adjusted orthoses can be considered as an option pre-operatively. This work was supported by the Finnish Office for Health Technology Assessment.

Publication Types:

• Meeting Abstracts

Keywords:

• Clinical Protocols
• Clinical Trials as Topic
• Control Groups
• Costs and Cost Analysis
• Foot Deformities, Acquired
• Hallux Valgus
• Humans
• Orthotic Devices
• Osteotomy
• Pain
• Pain Measurement
• economics
• surgery
• hsrmtgs

Other ID:

• GWHSR0000363

UI: 102272037

From Meeting Abstracts