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Background: Hallux valgus is a common indication for foot surgery. Over 25% of patients are dissatisfied with the outcome. Objective: To examine women's pre- and post-surgical characteristics, regarding satisfaction with surgery for hallux valgus ('bunions'). Method: Prospective cohort of 95 consecutive female patients (132 'foot cases') undergoing bunion surgery. Baseline interview and questionnaire asked about attitudes to fashion and footwear, plus SF-36 general health survey. At 12 months post-surgery, patients who were 'very pleased' with their surgery were compared with everyone else regarding their pre-, peri- and post-operative characteristics. Results: By 12 months, key SF-36 domains had significantly improved. The 75 foot operations (n = 75/116, 64.7%) were associated with respondents being 'very pleased' with their foot surgery. Following adjustment, the odds of being 'very pleased' were severely reduced where respondents were not 'very pleased' their foot's appearance (p < 0.001), or where foot pain was anything but absent (p = 0.018). There was significant interaction between pre-operative expectations of resumption of hiking/sports activities and range of footwear able to be worn post-operatively. Conclusions: The perceived appearance of their foot and range of shoes that women can wear, are crucial to womens' satisfaction with the outcome of bunion surgery. The (total) alleviation of pain is also important. © 2006 Elsevier Ltd. All rights reserved.

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