Taux de satisfaction après traitement d’un hallux valgus sévère par ostéotomie Scarf ou par arthrodèse métatarso-phalangienne

Abstract

INTRODUCTION: Severe hallux valgus (HV) is a less common entity, but more difficult to treat. Treatment may be conservative or not. The main objective of this study was to evaluate the satisfaction rate of operated patients in two series of severe HV corrected with Scarf osteotomy with plate osteosynthesis or by arthrodesis of the first metatarsophalangeal joint (MTP1) with a minimum follow-up of one year. The hypothesis was arthrodesis is better in terms of satisfaction and quality of results.MATERIAL AND METHODS: An ambispective, monocentric, single-operator study was conducted between 2015 and 2021. 61 feet (25 arthrodeses and 36 Scarf) were included with a median follow-up of 52.6 months. Data collected were satisfaction, adaptation to footwear, chronic pain, complications and recurrences.RESULTS: HV operated by arthrodesis had better functional results, with p<0.001; a satisfaction rate of 92% (60% very satisfied and 32% satisfied) vs 75% in the Scarf group (28% very satisfied and 47% satisfied), less adaptation to footwear (16% vs. 45%) and less persistent pain (12% vs. 42%). Complications and reworking appeared to be more frequent in Scarf group. Scarf group had 3 hallux varus evolutions (9%) and 9 recurrences (26%).CONCLUSION: A comparison of treatment of severe HV with metatarsophalangeal arthrodesis or Scarf osteotomy showed a better satisfaction rate and functional results for HV operated by arthrodesis. There was no significant difference in complication and revision rates, but hallux varus and hypocorrections were observed in the Scarf group.Level of evidence: III; Ambispective cohort study.