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CompletedNCT03340415Updated Mar 24, 2021Results posted

Timing of Weight Bearing After Hallux Valgus Surgery

An interventional study of Accelerated Rehabilitation plan in Hallux Valgus and Bunion, sponsored by North District Hospital. Completed at 1 site in Hong Kong. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-03-24.

Sponsored by North District Hospital · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
53
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Investigate the optimal timing for weight bearing after Hallux Valgus surgery. Hypothesis: Early weight bearing does not affect outcome after the Endoscopic Distal Soft Tissue Procedure for Hallux Valgus Correction.

Read the detailed description

Introduction:

  • Rehabilitation plans after hallux valgus/bunion surgery is varied
  • From a patient's perspective, full weight bearing is paramount for quality of life and return to work/study
  • No high-level study showing the optimal time to resume full weight bearing available

Hypothesis:

Early weight bearing (at 2 weeks post-op) does not affect outcome after the Endoscopic Distal Soft Tissue Procedure for Hallux Valgus correction

Trial Design:

  • Parallel group
  • Random allocation
  • Operating Surgeon blind to randomisation

Study Setting:

  • General Regional Hospital
  • Single Centre
02

Conditions studied

  • Hallux Valgus and Bunion

Keywords

  • Hallux Valgus
  • Bunion
  • Post-operative
  • Rehabilitation
  • Weight Bearing Status
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • All patients undergoing the EDSTP recruited

Exclusion criteria

Exclusion Criteria:

  • Cases requiring additional procedures (eg 2nd toe correction)
  • Mental incapacitation
  • Physical disability hindering rehabilitation (eg CVA, neurological disorder)
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Investigator)
Enrollment
53 participants (actual)

Study arms

  • No intervention
    Control Rehab

    Follow existing rehabilitation protocol of Non-weight bearing walking for 6 weeks followed by heel walking for 6 weeks; then the resumption of normal full weight-bearing walking in normal shoes at 12 weeks post-operation

  • Experimental
    Accelerated Rehab

    Accelerated rehabilitation protocol of non-weight bearing walking for 2 weeks followed by heel walking for 10 weeks; then the resumption of normal full weight-bearing walking in normal shoes at 12 weeks post-operation

    Other: Accelerated Rehabilitation plan

Interventions

  • OtherAccelerated Rehabilitation plan

    early weight bearing after surgery

05

What researchers measure

Primary outcomes

  1. Hallux Valgus Angle as a Measure of the Radiological Changes

    Weight bearing feet X-Ray to measure radiological parameters of hallux valgus. A larger angle represents the more severe condition. This is the angle between the 1st metatarsal and the proximal phalanx.

    Time frame: 0, 12, 26 weeks post-surgery

  2. Inter-metatarsal Angle as a Measure of the Radiological Changes

    Weight bearing feet X-Ray to measure radiological parameters of hallux valgus. A larger angle represents the more severe condition. This is measure using the bisecting line between the 1st metatarsal and the 2nd metatarsal.

    Time frame: 0, 12, 26 weeks post-surgery

  3. Radiological Changes (Tibial Sesamoid Position)

    Weight bearing feet X-Ray to measure radiological parameters of hallux valgus. 4 represents the most neutral position. bigger difference from 4 means more severe condition. This a score from 0-7.

    Time frame: 0, 12, 26 weeks post-surgery

Secondary outcomes

  1. Foot Function (FAOS Symptoms)

    Calculation of foot function using the self-reported Foot and Ankle Outcome Score (FAOS): FAOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport and Recreation), and foot and ankle-related Quality of Life (QOL). The last week is taken into consideration when answering the questionnaire. Standardized answer options are given (% Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

    Time frame: 0, 12, 26 week post-surgery

  2. Foot Function (FAOS Pain)

    Calculation of foot function using the self-reported Foot and Ankle Outcome Score (FAOS): FAOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport and Recreation), and foot and ankle-related Quality of Life (QOL). The last week is taken into consideration when answering the questionnaire. Standardized answer options are given (% Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

    Time frame: 0, 12, 26 week post-surgery

  3. Foot Function (FAOS ADL)

    Calculation of foot function using the self-reported Foot and Ankle Outcome Score (FAOS): FAOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport and Recreation), and foot and ankle-related Quality of Life (QOL). The last week is taken into consideration when answering the questionnaire. Standardized answer options are given (% Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

    Time frame: 0, 12, 26 week post-surgery

  4. Foot Function (FAOS Sport)

    Calculation of foot function using the self-reported Foot and Ankle Outcome Score (FAOS): FAOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport and Recreation), and foot and ankle-related Quality of Life (QOL). The last week is taken into consideration when answering the questionnaire. Standardized answer options are given (% Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

    Time frame: 0, 12, 26 week post-surgery

  5. Foot Function (FAOS QoL)

    Calculation of foot function using the self-reported Foot and Ankle Outcome Score (FAOS): FAOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport and Recreation), and foot and ankle-related Quality of Life (QOL). The last week is taken into consideration when answering the questionnaire. Standardized answer options are given (% Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

    Time frame: 0, 12, 26 week post-surgery

06

Results

Posted Mar 24, 2021

Participant flow

Participant flow — Overall Study
MilestoneControl RehabAccelerated Rehab
Started2924
Completed2921
Not completed03

Outcome measures

PrimaryHallux Valgus Angle as a Measure of the Radiological Changes

Weight bearing feet X-Ray to measure radiological parameters of hallux valgus. A larger angle represents the more severe condition. This is the angle between the 1st metatarsal and the proximal phalanx.

Time frame:
0, 12, 26 weeks post-surgery
Reported as:
Mean · degrees
Hallux Valgus Angle as a Measure of the Radiological Changes
degreesControl RehabAccelerated Rehab
0 week35.6 ± 7.137.4 ± 8.0
12 week8.8 ± 5.27.2 ± 4.8
26 week11.6 ± 7.610.5 ± 6.2
PrimaryInter-metatarsal Angle as a Measure of the Radiological Changes

Weight bearing feet X-Ray to measure radiological parameters of hallux valgus. A larger angle represents the more severe condition. This is measure using the bisecting line between the 1st metatarsal and the 2nd metatarsal.

Time frame:
0, 12, 26 weeks post-surgery
Reported as:
Mean · degrees
Inter-metatarsal Angle as a Measure of the Radiological Changes
degreesControl RehabAccelerated Rehab
0 week14.0 ± 3.016.4 ± 3.7
12 week6.2 ± 1.97.2 ± 2.2
26 week7.7 ± 2.77.3 ± 2.4
PrimaryRadiological Changes (Tibial Sesamoid Position)

Weight bearing feet X-Ray to measure radiological parameters of hallux valgus. 4 represents the most neutral position. bigger difference from 4 means more severe condition. This a score from 0-7.

Time frame:
0, 12, 26 weeks post-surgery
Reported as:
Mean · units on a scale
Radiological Changes (Tibial Sesamoid Position)
units on a scaleControl RehabAccelerated Rehab
0 week5.55 ± 1.25.6 ± 1.1
12 week2.6 ± 1.23.0 ± 0.9
26 week2.9 ± 1.33.0 ± 1.0
SecondaryFoot Function (FAOS Symptoms)

Calculation of foot function using the self-reported Foot and Ankle Outcome Score (FAOS): FAOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport and Recreation), and foot and ankle-related Quality of Life (QOL). The last week is taken into consideration when answering the questionnaire. Standardized answer options are given (% Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

Time frame:
0, 12, 26 week post-surgery
Reported as:
Mean · score on a scale
Foot Function (FAOS Symptoms)
score on a scaleControl 6-wk NWBEarly 2 Week NWB
0 week58.3 ± 26.147.5 ± 23.9
12 week62.1 ± 16.176.9 ± 13.6
26 week81.9 ± 11.880.5 ± 15.6
SecondaryFoot Function (FAOS Pain)

Calculation of foot function using the self-reported Foot and Ankle Outcome Score (FAOS): FAOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport and Recreation), and foot and ankle-related Quality of Life (QOL). The last week is taken into consideration when answering the questionnaire. Standardized answer options are given (% Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

Time frame:
0, 12, 26 week post-surgery
Reported as:
Mean · score on a scale
Foot Function (FAOS Pain)
score on a scaleControl 6-wk NWBEarly 2 Week NWB
0 week44 ± 23.847.5 ± 28.8
12 week66.4 ± 19.378.6 ± 11.4
26 week82.2 ± 15.685.5 ± 12.9
SecondaryFoot Function (FAOS ADL)

Calculation of foot function using the self-reported Foot and Ankle Outcome Score (FAOS): FAOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport and Recreation), and foot and ankle-related Quality of Life (QOL). The last week is taken into consideration when answering the questionnaire. Standardized answer options are given (% Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

Time frame:
0, 12, 26 week post-surgery
Reported as:
Mean · score on a scale
Foot Function (FAOS ADL)
score on a scaleControl 6-wk NWBEarly 2 Week NWB
0 week59.7 ± 29.453.0 ± 25.6
12 week61.4 ± 17.381.4 ± 7.6
26 week84.3 ± 10.686.0 ± 8.2
SecondaryFoot Function (FAOS Sport)

Calculation of foot function using the self-reported Foot and Ankle Outcome Score (FAOS): FAOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport and Recreation), and foot and ankle-related Quality of Life (QOL). The last week is taken into consideration when answering the questionnaire. Standardized answer options are given (% Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

Time frame:
0, 12, 26 week post-surgery
Reported as:
Mean · score on a scale
Foot Function (FAOS Sport)
score on a scaleControl 6-wk NWBEarly 2 Week NWB
0 week52.1 ± 29.739.8 ± 26.7
12 weekNA ± NANA ± NA
26 week76.7 ± 15.777.6 ± 13.7
SecondaryFoot Function (FAOS QoL)

Calculation of foot function using the self-reported Foot and Ankle Outcome Score (FAOS): FAOS consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport and Recreation), and foot and ankle-related Quality of Life (QOL). The last week is taken into consideration when answering the questionnaire. Standardized answer options are given (% Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.

Time frame:
0, 12, 26 week post-surgery
Reported as:
Mean · score on a scale
Foot Function (FAOS QoL)
score on a scaleControl 6-wk NWBEarly 2 Week NWB
0 week41.2 ± 30.231.1 ± 23.6
12 week49.1 ± 20.472.6 ± 20.7
26 week82.4 ± 11.281.4 ± 14.9

Adverse events

Collected over 1 year. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Control Rehab0/29 (0%)0/29 (0%)0/29 (0%)
Accelerated Rehab0/24 (0%)0/24 (0%)0/24 (0%)

Baseline characteristics

Age, Continuous
Age, Continuous(years)Control RehabAccelerated RehabTotal
Median60 (25 to 71)60 (25 to 71)60 (25 to 71)
Sex: Female, Male
Sex: Female, Male(Participants)Control RehabAccelerated RehabTotal
Female261945
Male325
Race and Ethnicity Not Collected
Race and Ethnicity Not Collected(Participants)Control RehabAccelerated RehabTotal
Count of participants——0
Region of Enrollment
Region of Enrollment(participants)Control RehabAccelerated RehabTotal
Hong Kong292150
07

Study locations

1 site
  • North District Hospital
    Hong Kong, Hong Kong
08

References and documents

Publications

  • Lui TH, Ling SK, Yuen SC. Endoscopic-assisted Correction of Hallux Valgus Deformity. Sports Med Arthrosc Rev. 2016 Mar;24(1):e8-13. doi: 10.1097/JSA.0000000000000078. PubMed 26752780 ↗
  • Lui TH. Correction of Recurred Hallux Valgus Deformity by Endoscopic Distal Soft Tissue Procedure. Arthrosc Tech. 2017 Apr 10;6(2):e435-e440. doi: 10.1016/j.eats.2016.10.022. eCollection 2017 Apr. PubMed 28580264 ↗
  • Lui TH, Ng S, Chan KB. Endoscopic distal soft tissue procedure in hallux valgus surgery. Arthroscopy. 2005 Nov;21(11):1403. doi: 10.1016/j.arthro.2005.08.015. PubMed 16325100 ↗
  • Lui TH, Chan KB, Chan LK. Endoscopic distal soft-tissue release in the treatment of hallux valgus: a cadaveric study. Arthroscopy. 2010 Aug;26(8):1111-6. doi: 10.1016/j.arthro.2009.12.027. PubMed 20678710 ↗

Study documents

  • Protocol and statistical analysis plan · Mar 19, 2018

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT03340415
Lead sponsor
North District Hospital
Collaborators
Chinese University of Hong Kong
Responsible party
Samuel KK Ling (Orthopaedic Surgeon, Chinese University of Hong Kong) — Principal investigator
First posted
Nov 13, 2017
Start date
Jul 13, 2018
Primary completion
Jun 30, 2019
Completion
Apr 30, 2020
Results posted
Mar 24, 2021
Last update
Mar 24, 2021

Study contacts

Samuel KK Ling, MBChB
principal investigator · Dept of Orthopaedics & Traumatology, the Chinese University of Hong Kong

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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