The combined reverse scarf and opening wedge osteotomy of the proximal phalanx for the treatment of iatrogenic hallux varus

Abstract

Backgrond : Hallux varus is a complication of hallux valgus surgery. Historically the standard treatment has been to arthrodese the first metatarso-phalangeal (MTP) joint. More recently other options have come to light, including reverse osteotomies and tendon-transfer procedures. Objectives : This paper presents a small retrospective audit of patients who developed hallux varus following the combined rotation scarf and Akin osteotomy for hallux valgus, and their subsequent treatment with a stepwise approach of soft tissue release and ultimately reverse scarf osteotomy and opening wedge osteotomy of the proximal phalanx. Method : Five patients attended for a retrospective audit including reasons for revision surgery, review of intermetatarsal (IM) and first metatarso-phalangeal joint (MTPA) angles, AOFAS scores and patient satisfaction. Results : At a mean follow up of 38 months, mean IM angle and MTP joint angle improved from 5 to 9° and −10° to 11° respectively. Mean first MTP joint dorsiflexion and plantarflexion was 26° and 19° respectively. One patient was completely satisfied and four were satisfied with reservations with their surgical outcome and 100% felt they were better off as a result of their surgery. Conclusion : The stepwise approach to the reverse scarf and opening wedge osteotomy of the proximal phalanx for iatrogenic hallux varus is an alternative to first MTP joint arthrodesis for those with a viable joint.