Early postoperative activity tracking shows excessive ambulation and poor adherence to recommendations after hallux valgus surgery - 29/03/26

Doi : 10.1016/j.otsr.2026.104689

Julien Beldame ^a,^b, Alessandro Civinini ^c,^d,^e, Pauline Brevet ^f, Nicolas Kloek ^c,^d, Timothée Gillot ^c,^g, Matthieu Lalevée ^c,^d,⁎ , Marie-Anne Melone ^c

^a Institut de la Cheville et du Pied Amiens, 85 Av. d'Irlande, 80000 Amiens, France

^b Institut de la Cheville et du Pied Paris, Clinique Jouvenet - Ramsay Santé, 6 Sq. Jouvenet, 75016 Paris, France

^c Normandie Univ, UNIROUEN, CETAPS UR3832, Groupe d'Etude Normand Interdisciplinaire de l'Appareil Locomoteur (GENIAL), 1 rue de Germont, F-76000 Rouen, France

^d Rouen University Hospital, Orthopedic and Trauma Surgery Department, 37 Boulevard Gambetta, 76000 Rouen, France

^e Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, Firenze, 50139, Italy

^f Department of Rheumatology, Groupe Hospitalier du Havre, Montivilliers, France

^g CHU Rouen, IFMK de Rouen, F-76000 Rouen, France

^⁎ Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 29 March 2026

Abstract

Background

Currently, there is limited information regarding postoperative adherence to surgeon recommendations following hallux valgus surgery. This prospective study aimed to assess early postoperative ambulation and adherence to recommendations using a GPS-enabled wearable device during the postoperative period.

Hypothesis

We hypothesized that patients undergoing hallux valgus surgery would exhibit high postoperative activity levels and poor adherence to surgeon recommendations.

Patients and methods

A prospective, single-center cohort study was conducted from February to July 2024, including 24 consecutive patients (8 males, 16 females; mean age 53.2 ± 8.3 years) undergoing minimally invasive hallux valgus surgical correction (distal chevron osteotomy, and Akin). A GPS tracker with a 3-axis accelerometer was incorporated into the postoperative dressing, recording step count, movement duration, and location from postoperative Days 1–5. Patients were recommended home rest for the first five postoperative days and to limit ambulation using a postoperative shoe, restricted to essential activities. Adherence to recommendations was assessed based on recorded activity levels and distances traveled. Pain was monitored using a visual analog scale.

Results

Patients exhibited high postoperative ambulation. In total (17/24) 70% engaged in outdoor activity beyond 1 km, and (11/24) 47% walked more than 2000 steps per day. Step count increased significantly from 1797 ± 2397 on Day 1–2937 ± 2140 on Day 5 (p = 0.002). Activity duration also increased from 164 ± 88 min on Day 1–222 ± 95 min on Day 4 (p = 0.002). Pain levels exhibited a significant inverse relationship with activity duration (ρ = −0.26 (p = 0.01)). No postoperative complications were observed at follow-up.

Discussion

Our study showed high activity levels and poor compliance with postoperative recommendations following hallux valgus surgery during the early postoperative phase. Despite the absence of complications, these findings do not support relaxing postoperative activity restrictions based on this limited cohort. GPS-based wearable tracking might have a potential role in improving postoperative surveillance and refining patient care guidelines.

Level of evidence

IV; prospective case series

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Keywords : Early ambulation, Ambulation score, Physical activity, Hallux valgus deformity, Hallux valgus deformity correction, Minimally invasive metatarsal osteotomy