Do all bunions need surgery? An investigation of Google searches for Hallux Valgus

Abstract

Introduction: Hallux valgus (HV) or a bunion is one of the most common forefoot deformities. Approximately one in four adults will develop HV with a higher prevalence in adult females. Given the high prevalence of HV along with the wide variety of non-surgical and surgical treatment options for it, we believe patients are likely turning to internet search engines for questions germane to HV. Previous orthopaedic investigations have used Google’s “People Also Ask” box to characterize frequently asked questions (FAQs) regarding total knee and hip arthroplasty. Yet, no such investigation has been conducted for HV. Using Google’s Frequently Asked Questions (FAQs), we sought to classify these questions as well as assess their levels quality and transparency.

Methods: On October 9, 2022, we searched Google using these four phrases: “Hallux Valgus Treatment,” “Hallux Valgus Treatment Surgery,” “Bunion Treatment,” and “Bunion Surgery.” We refreshed search results until a minimum of 100 FAQs were produced; we extracted the sources of these 100 questions for content analysis. Information transparency was assessed using the Journal of the American Medical Association’s (JAMA) Benchmark tool, question classification was defined using the Rothwell Classification of Questions, and information quality was assessed using Brief DISCERN. This study was approved by an IRB.

Results section: Our Google search returned 299 unique FAQs after removing duplicates and unrelated FAQs. The majority were classified as fact based questions (149/299, 49.8%), followed by value (92/299, 30.8%) and policy questions (58/299, 19.4%). Overall the most common topic searched was related to the evaluation of treatment or surgery (79/299, 26.4%). The frequent answer sources were medical practices (158/299, 52.8%), followed by commercial (69/299, 23.1%) and academic (38/299, 12.7%). The one-way analysis of variance revealed a significant difference in mean quality scores among the 5 source types (F= 54.49, P<.001) with medical practices averaging the worst score (12.1/30) compared to academic sources which were found to have the highest score (21.8/30).

Discussion: Patients seeking online information concerning treatment options for HV appear to search Google for questions related to treatment efficacy and restrictions. The most common source type encountered by patients are small medical practices; these were found to have both poor transparency and poor quality. Our study has several limitations, JAMA benchmark and Brief DISCERN do not assess the accuracy of the information. Secondly, our study is cross-sectional in design limiting the generalizability of our findings to the time when the search was performed.

Significance/Clinical Relevance: In order to increase the transparency and quality of online information regarding HV treatment, online sources should refer to established rubrics such as JAMA benchmark and Brief DISCERN when publishing online information. Physicians should be aware that patients are commonly searching for information related to the evaluation of treatments or surgeries for HV.