The rotation Scarf and Akin osteotomy for the correction of severe hallux valgus

Abstract

Background: The Scarf osteotomy is a mid shaft osteotomy of the first metatarsal. Like other distal and mid-shaft osteotomies there is probably a limit to the amount of intermetatarsal (IM) angle correction that can be achieved, restricting the indications for the Scarf to moderate hallux valgus only. We have modified the Scarf osteotomy to allow rotation of the metatarsal and combined it with a closing wedge osteotomy of the hallux for the correction of severe hallux valgus. Objectives: The following prospective study seeks to provide evidence of the effectiveness of the rotation Scarf and Akin procedure for the treatment of severe hallux valgus with high intermetatarsal angles or metatarsus adductus. Method: Thirty-five patients (50 feet) underwent a rotation Scarf and Akin osteotomy and were reviewed at an average of 28 months postoperatively. Using pre- and post-operative weightbearing X-rays, the intermetatarsal angle, hallux valgus angle, distal metatarsal articular angle (DMAA), metatarsal length, and tibial sesamoid position were measured. The AOFAS clinical rating scale was used preoperatively and at final review and a visual analogue scale was used to measure patient satisfaction. Results: Preoperatively, the mean intermetatarsal angle was 16 and 5° postoperatively. Preoperatively the mean hallux valgus angle was 39 and 15° postoperatively. DMAA was reduced by an average of 10° and the tibial sesamoid position improved by an average of two positions. The AOFAS clinical rating scale improved by an average of 46 points and 92% of patients were completely satisfied with their result. Conclusion: The rotation Scarf and Akin osteotomy is a safe and effective procedure for the treatment of severe hallux valgus with high intermetatarsal angles or metatarsus adductus.