Abstract
BackgroundScarf osteotomy (SO) was broadly applied in moderate to severe hallux valgus (MSHV), and the results were satisfactory. However, due to the complicated pathologic changes in hallux valgus, the ideal surgical treatment is still controversial. Transfer of the abductor hallucis tendon combined with Scarf osteotomy (TAHTCSO) was an innovative alternative technique. This retrospective cohort study aimed to define if TAHTCSO mode resulted in improved outcomes as compared with the single SO in MSHV.MethodsOf 73 patients (92 ft) with MSHV, 36 (45 ft) were treated through TAHTCSO and 37 ones (47 ft) through SO. The patients were assessed clinically and radiographically with a 24-month follow-up. They were assessed pre-operatively and post-operatively with intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), first metatarsophalangeal joint range of motion (1#MTP ROM), as well as American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores and postoperative complications of surgery.ResultsBoth cohorts had the same baseline feathures. All patients were followed up from 24 to 40 months, with a mean of 28.3 months. Patients in the TAHTCSO cohort had significantly decreased HVA at 6 months (p < 0.0001), 12 months (p < 0.0001), and 24 months (p < 0.0001) after surgery. 1#MTP had been increased slightly with non-statistic sense (p>0.05). IMA, DMAA and AOFAS also had not significantly difference at all followed time after surgery as compared with the SO cohort. The healing of osteotomies was observed within 8 weeks in the two cohorts. Two cases of hallus varus had been found in SO cohort and there were no cases of delayed healing and bone non-union in both cohorts.ConclusionIn this retrospective cohort study, TAHTCSO had sufficient maintenance of the correction and improved functional performance thereby was a good alternative for MSHV, though it did not display a better result for MSHV compared to SO.
Highlights
Moderate to severe hallux valgus deformity is defined as intermetatarsal angle (IMA) of more than 13 degrees [1]
Eligible patients were included in this research once they met the following criteria: (1) Diagnosed with moderate to severe hallux valgus (MSHV) (IMA more than 13 degrees), (2) were over 18 years of old and in full possession of their mental faculties, (3) had severe pain, (4) patients treated with TAHTCSO were included in TAHTCSO group or treated with Scarf osteotomy (SO) were included in SO group, and were follow-up until 24 months, (5) first metatarsal osteotomy by a single surgeon, and (6) symptomatic hallux valgus associated with increased distal metatarsal articular angle (DMAA) (≥15°)
Two cases of hallus varus and three cases of troughing were found in SO cohor; there were no cases of delayed healing and bone non-union in both cohorts (Table 2)
Summary
Moderate to severe hallux valgus deformity is defined as intermetatarsal angle (IMA) of more than 13 degrees [1]. It often occurs in the aged population with assessed occurrence of 36% in people over 65 years [2]. The unique and most appropriate MSHV treatment remain elusive The diaphyseal osteotomies such as Scarf osteotomy have gained popularity in recent years [6]. Transfer of the abductor hallucis tendon combined with Scarf osteotomy (TAHTCSO) was an innovative alternative technique
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