When it is necessary to perform an additional akin osteotomy with a scarf osteotomy for mild and moderate deformities of hallux valgus?

Abstract

SummaryIntroduction. Scarf osteotomy is a common method of treating acquired hallux valgus deformity today. At the same time, as a result of scarf osteotomy, the pathological hallux valgus interphalangeal angle (HVIPA) is not elimi-nated. In order to correct the latter, it is possible to per-form an osteotomy of the base of the main phalanx of the 1st finger (Akin osteotomy). There is a limited amount of objective data comparing the radiological and functional results of treatment of patients with mild and moderate HV deformity who underwent solely either scarf osteo-tomy or scarf osteotomy in combination with additional Akin osteotomy. The aim of the study was to compare the clinical and radiological results of isolated scarf osteo-tomy and a double scarf and Akin osteotomy in patients with mild and moderate HV forefoot deformity. Materials and methods. The study included 187 patients (187 feet) with HV anterior deformity of mild and moderate severi-ty, who were divided into 2 groups. The first group, where Akin surgery was performed in addition to scarf osteoto-my, consisted of 86 patients (86 feet). 101 patients (101 feet) were included in the second group, where only scarf osteotomy was performed. According to all indicators, the patients of the groups were comparable and had no significant differences. The exception was the hallux val-gus interphalangeal angle (HVIPA), which was significant-ly larger in the first group A, since the threshold value for performing an additional Akin osteotomy was the HVIPA value of 9° or more. All patients underwent clinical exam-ination, X-ray control and questionnaires of AOFAS, VAS and MOXFQ scales before surgery, as well as on the 12thand 24th months after surgery. An objective assessment of the quality of hallux valgus deformation elimination was carried out according to three angular indicators: hallux valgus interphalangeal angle (interphalageal an-gle — HVIPA), hallux valgus angle (hallux valgus angle — HVA), the first interplatarsal angle (1–2 intermaetatarsal angle — 1–2 IMA). Results. There was no statistically sig-nificant difference in anatomical and functional results of treatment of patients of the studied groups. In addition, there were no significant changes in the studied indica-tors at 12 and 24 months after surgery, both within each group and in comparison of the groups with each other. Conclusion. To achieve good results when correcting the hallux valgus of the first toe, the anatomy of the phalan-ges of the first toe should be taken into account. Liter-ature data, as well as the results of our studies indicate that correction of valgus deformity of the interphalangeal joint with an HVIPA of 9° or more is recommended to pre-vent loss of correction after osteotomy of the first meta-tarsal. Despite the increase in the traumatic nature of the intervention, Akin osteotomy performed in addition to scarf osteotomy according to appropriate indications does not require correction of the postoperative rehabili-tation program, does not adversely affect the anatomical and functional outcome of treatment, does not lead to an increase in the proportion of complications.