Retrospective study of 170 hallux valgus surgery patients establishing MCID thresholds for VAS pain and FAAM-ADL scores. Three calculation methods were compared, and logistic regression identified which patient and procedural factors predict crossing the meaningful improvement threshold. Follow-up averaged 23.6 months.
The raw VAS score change after hallux valgus surgery tells you something happened — but not whether it mattered to the patient. Before MCID thresholds were established for these instruments, there was no objective benchmark to distinguish real improvement from measurement noise.
In clinic, use a preoperative VAS pain score of 5 as a decision-relevant threshold. Patients below this cutoff are significantly less likely to cross the MCID, regardless of how technically successful the procedure is. Set expectations explicitly: "Your pain level is relatively mild; surgery may not produce a change that feels meaningful to you."
For deformity severity, mild cases treated with distal or phalangeal procedures have the lowest odds of reaching meaningful pain improvement. Moderate and severe cases corrected with Ludloff or Lapidus procedures are 2-3 times more likely to cross the threshold. Which also reflects that they start with more pain and structural pathology to correct.
The authors caution that anchor-based methods may overestimate the true MCID in hallux valgus because satisfied and dissatisfied groups diverge over time, artificially widening the gap. The SD-based thresholds (VAS 1.8, FAAM-ADL 11.1) are likely the most conservative and practically useful benchmarks for clinical reporting.
Determination of Minimum Clinically Important Difference (mcid) in Visual Analog Scale (vas) Pain and Foot and Ankle Ability Measure (faam) Scores after Hallux Valgus Surgery
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Retrospective study of 170 hallux valgus surgery patients establishing MCID thresholds for VAS pain and FAAM-ADL scores. Three calculation methods were compared, and logistic regression identified which patient and procedural factors predict crossing the meaningful improvement threshold. Follow-up averaged 23.6 months.
The raw VAS score change after hallux valgus surgery tells you something happened — but not whether it mattered to the patient. Before MCID thresholds were established for these instruments, there was no objective benchmark to distinguish real improvement from measurement noise.
In clinic, use a preoperative VAS pain score of 5 as a decision-relevant threshold. Patients below this cutoff are significantly less likely to cross the MCID, regardless of how technically successful the procedure is. Set expectations explicitly: "Your pain level is relatively mild; surgery may not produce a change that feels meaningful to you."
For deformity severity, mild cases treated with distal or phalangeal procedures have the lowest odds of reaching meaningful pain improvement. Moderate and severe cases corrected with Ludloff or Lapidus procedures are 2-3 times more likely to cross the threshold. Which also reflects that they start with more pain and structural pathology to correct.
The authors caution that anchor-based methods may overestimate the true MCID in hallux valgus because satisfied and dissatisfied groups diverge over time, artificially widening the gap. The SD-based thresholds (VAS 1.8, FAAM-ADL 11.1) are likely the most conservative and practically useful benchmarks for clinical reporting.