{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:16:44Z","timestamp":1777612604821,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2019,4,22]],"date-time":"2019-04-22T00:00:00Z","timestamp":1555891200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Some US insurance companies have recently started to require minimum angular measurements, for coverage decisions, in patients seeking operative correction for symptomatic hallux valgus. This logic naturally assumes that the magnitude of radiographic bunion deformity is related to the magnitude of patient\u2019s presenting symptoms and\/or disability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted an analysis of existing data in our practice to determine whether patient-reported symptoms and disability prior to bunion surgery correlated with preoperative radiographic measurements commonly used to quantify hallux valgus severity. Symptoms and disability level were determined using patient-reported preoperative Foot and Ankle Outcome Score (FAOS), a validated instrument commonly used in hallux valgus assessment. Spearman correlation coefficient was then used to quantify the strength of any correlations. Preoperative data from 107 patients (107 feet) with mean age of 49.3 \u00b1 13.8 years who underwent isolated osseous hallux valgus surgery within our practice between June 1, 2016, and July 30, 2018, were available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>No radiographic variable achieved even a moderate correlation with any of the FAOS subscales with the exception of tibial sesamoid position with FAOS Pain (rho=0.402, P = .01) in patients aged 56 years and older. The direction of this correlation was positive, indicating that greater preoperative sesamoid abnormalities were paradoxically associated with less presenting pain (ie, higher FAOS Pain scores).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>It would appear that radiographic severity of bunion deformity is not well correlated with symptom level and\/or disability and, we would argue, should not play a role in coverage decisions for patients presenting for hallux valgus surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level IV, retrospective case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1071100719845002","type":"journal-article","created":{"date-parts":[[2019,4,22]],"date-time":"2019-04-22T03:19:47Z","timestamp":1555903187000},"page":"923-928","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Correlation of Preoperative Radiographic Severity With Disability and Symptom Severity in Hallux Valgus"],"prefix":"10.1177","volume":"40","author":[{"given":"Michael","family":"Matthews","sequence":"first","affiliation":[{"name":"Weil Foot and Ankle Institute, Des Plaines, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Klein","sequence":"additional","affiliation":[{"name":"Weil Foot and Ankle Institute, Des Plaines, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyse","family":"Acciani","sequence":"additional","affiliation":[{"name":"Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Sorensen","sequence":"additional","affiliation":[{"name":"Weil Foot and Ankle Institute, Des Plaines, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Lowell","family":"Weil","sequence":"additional","affiliation":[{"name":"Weil Foot and Ankle Institute, Des Plaines, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Sr","given":"Lowell S.","family":"Weil","sequence":"additional","affiliation":[{"name":"Weil Foot and Ankle Institute, Des Plaines, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Fleischer","sequence":"additional","affiliation":[{"name":"Weil Foot and Ankle Institute, Des Plaines, IL, USA"},{"name":"Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,4,22]]},"reference":[{"key":"bibr1-1071100719845002","unstructured":"AETNA. Bunionectomy: clinical policy bulletins. http:\/\/www.aetna.com\/cpb\/medical\/data\/600_699\/0629.html. Published 2018. Accessed February 19, 2019."},{"key":"bibr2-1071100719845002","unstructured":"AmeriHealth Caritas. Clinical policy title: Bunionectomy (hallux valgus surgery). 2018: 1-9. http:\/\/amerihealthcaritasvipcareplus.com\/global\/assets\/pdf\/provider\/clinical-policies\/ccp1311-1906-bunionectomy-hallux-valgus-surgery.pdf. Accessed November 10, 2018."},{"key":"bibr3-1071100719845002","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.308.6933.896"},{"key":"bibr4-1071100719845002","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsr1412118"},{"key":"bibr5-1071100719845002","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2012.1145"},{"key":"bibr6-1071100719845002","volume-title":"Foot and Ankle Radiology","author":"Christman RA.","year":"2015","edition":"2"},{"key":"bibr7-1071100719845002","doi-asserted-by":"publisher","DOI":"10.1111\/1911-3846.12155"},{"key":"bibr8-1071100719845002","doi-asserted-by":"publisher","DOI":"10.7547\/87507315-73-12-620"},{"key":"bibr9-1071100719845002","doi-asserted-by":"publisher","DOI":"10.1177\/1071100714524551"},{"key":"bibr10-1071100719845002","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.33B3.376"},{"key":"bibr11-1071100719845002","unstructured":"Harvard Pilgrim Health Care. Medial review criteria bunionec-tomy. 2018: 1-5. https:\/\/www.harvardpilgrim.org\/pls\/portal\/docs\/PAGE\/PROVIDERS\/MEDMGMT\/MEDICAL_REVIEW_CRITERIA\/BUNIONS_PUBLICATION_14MAR18_CLEAN.PDF. Accessed November 10, 2018."},{"issue":"32","key":"bibr12-1071100719845002","first-page":"1","volume":"7","author":"Hurn SE","year":"2014","journal-title":"J Foot Ankle Res"},{"key":"bibr13-1071100719845002","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1112351"},{"key":"bibr14-1071100719845002","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-2127-0"},{"key":"bibr15-1071100719845002","doi-asserted-by":"publisher","DOI":"10.1016\/S0958-2592(03)00047-6"},{"issue":"3","key":"bibr16-1071100719845002","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1002\/acr.20396","volume":"63","author":"Menz HB","year":"2011","journal-title":"Arthritis Care Res"},{"key":"bibr17-1071100719845002","doi-asserted-by":"publisher","DOI":"10.3109\/17453673008991145"},{"key":"bibr18-1071100719845002","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp0904131"},{"key":"bibr19-1071100719845002","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.B.00288"},{"key":"bibr20-1071100719845002","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.19.2474"},{"key":"bibr21-1071100719845002","unstructured":"United States Senate. HR 3590: The Patient Protection and Affordable Care Act; 2010."}],"container-title":["Foot &amp; Ankle International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1071100719845002","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1071100719845002","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1071100719845002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T21:23:26Z","timestamp":1777411406000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1071100719845002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,22]]},"references-count":21,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1177\/1071100719845002"],"URL":"https:\/\/doi.org\/10.1177\/1071100719845002","relation":{},"ISSN":["1071-1007","1944-7876"],"issn-type":[{"value":"1071-1007","type":"print"},{"value":"1944-7876","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,22]]}}}