Does the Severity of Bunions Affect Surgical Outcomes?

Hallux valgus, commonly referred to as a bunion, presents with varying degrees of deformity, ranging from mild angular deviation to more pronounced structural misalignment of the forefoot. While surgical correction is a recognised treatment option for symptomatic cases, questions remain about whether the severity of deformity at presentation influences postoperative outcomes.
 

A comparative clinical study published in Foot & Ankle International examined this question by analysing outcomes of scarf osteotomy across different severities of hallux valgus. The study provides evidence-based insight into how deformity severity relates to pain relief, functional recovery, and patient satisfaction following surgery.

Why Deformity Severity Has Been a Point of Clinical Debate

In clinical practice, hallux valgus (bunions) severity is commonly assessed using radiographic measurements such as the hallux valgus angle and intermetatarsal angle. More severe deformities are often assumed to be associated with:

• Greater technical difficulty during surgery
• Higher risk of residual symptoms
• Less predictable functional recovery
   

However, existing literature has offered limited comparative data to support or refute these assumptions. This gap formed the basis for the referenced study’s investigation.

Overview of the Comparative Study Design

The study reviewed 83 consecutive scarf osteotomies performed by a single surgeon for symptomatic hallux valgus over a four-year period. Patients were categorised into mild, moderate, and severe deformity groups based on preoperative radiographic measurements.
 

Clinical outcomes were assessed using multiple validated tools:

• Visual Analog Scale (VAS) for pain
• 36-Item Short Form Health Survey physical functioning (SFPF)
• 36-Item Short Form Health Survey mental health (SFMH)
• American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores
   

Assessments were conducted preoperatively, as well as at 6 months and 2 years postoperatively, allowing both short-term and mid-term outcomes to be evaluated.

Preoperative Comparisons Across Severity Groups

Before surgery, the study found no significant differences in most baseline outcome scores between the mild, moderate, and severe deformity groups. Measures of pain, physical function, mental health, and overall AOFAS scores were comparable.
 

One exception was related to second-toe AOFAS scores, which were poorer with increasing severity of hallux valgus. This finding reflects the secondary effects that more advanced deformity can have on adjacent toes.

Postoperative Outcomes: Pain, Function, and Satisfaction

Following surgery, all three severity groups demonstrated improvement across outcome measures.

• Pain scores (VAS) improved substantially across groups
• AOFAS scores reached high postoperative levels
• Patient satisfaction rates remained high at both follow-up points
   

Reported satisfaction rates at two years were similar across groups, with no statistically significant differences between patients with mild, moderate, or severe deformity.
 

These findings suggest that, within the study cohort, deformity severity did not preclude meaningful symptomatic improvement following scarf osteotomy.

Differences Observed in Functional Recovery

While overall outcomes were favourable, the study did identify subtle differences in physical function scores.
 

Patients in the severe deformity group recorded lower SFPF scores at both 6 months and 2 years postoperatively compared with those in the mild and moderate groups. Additionally, second-toe pain and function scores were slightly poorer in the severe group at two years.
 

Importantly, these differences did not translate into lower satisfaction rates or higher complication or revision rates.

Complications and Revision Rates

The study reported similar complication and revision rates across all three severity groups. This suggests that increased deformity severity was not associated with a higher risk of adverse outcomes within the observed follow-up period.

About the Research Contributor

Dr Seng Chusheng is a Consultant Orthopaedic Surgeon and one of the authors of this study. He holds a Bachelor of Medicine and Bachelor of Surgery and a Master of Medicine in Orthopaedic Surgery from the National University of Singapore, and is a Member and Fellow of the Royal College of Surgeons of Edinburgh.

Severity of bunions has long been considered a potential determinant of surgical outcome. The findings from this comparative series suggest that, for patients undergoing scarf osteotomy, overall pain relief and satisfaction may be achieved across mild to severe deformities, with some variation in functional recovery.
 

As with all surgical decisions, individual factors and clinical judgement remain central, and research such as this provides valuable data to inform evidence-based practice.

References

• Law G.W., Tay K.S., Lim J.W.S., Zhang K.T., Seng C., Yeo N.E.M., Koo K., Rikhraj I.S. Effect of severity of deformity on clinical outcomes of scarf osteotomies. Foot & Ankle International. 2020;41(6):705–713. PMID: 32129087.