Scarf Osteotomy Research Articles

Protocol: a randomized parallel-group study of women after hallux valgus correction surgery to compare the effects of "core foot system" training vs. traditional rehabilitation methods.

Purpose: The aim of this study is to compare the effects of Core Foot System muscle training vs. traditional rehabilitation methods in female patients after a hallux valgus correction surgery. Methods: The project will involve 60 women who have undergone a Scarf osteotomy to correct the deformity. Participants will be divided into a control and experimental group. The experimental group will follow the Core Foot System protocol, whereas the control group will perform standard lower-limb exercises. Outcome measures will be collected twice: before the intervention and after eight weeks. Gait will be assessed using the Zebris FDM-2 platform, measuring ground reaction forces during walking. Results: The effects of the exercises on the cross-sectional area of the abductor hallucis muscle and the flexor digitorum brevis muscle will be measured. Foot architecture and arch height will be measured using a podoscope. In addition, the participants will complete the Short Form Health Survey and the American Orthopaedic Foot and Ankle Society questionnaires. Conclusions: The study is expected to provide evidence of the effectiveness of foot muscle training using the protocol. The findings may lead to an improved protocol of rehabilitation in patients after a correction surgery that may result in improved gait parameters and quality of daily life. In the future, an improved therapeutic method should make it possible to boost the effectiveness of physiotherapy in patients after a corrective surgery in the forefoot area. The study has been registered with clinicaltrials.org (NCT05210127; 13 January 2022).

Case-control study on Scarf and double metatarsal osteotomy of the first metatarsal for the treatment of hallux valgus deformity

To compare clinical efficacy of scarf osteotomy and double metatarsal osteotomy(DMO) in treating moderate to severe hallux valgus. Fifty patients (81 feet) with moderate to severe hallux valgus deformity were treated from January 2017 to December 2019, and were divided into Scarf osteotomy (SO) group or DMO group according to different osteotomy methods. There were 26 patients (44 feet) in SO group, including 1 male and 25 females, aged from 48 to 65 years old with an average of (55.5±4.67) years old;18 patients (30 feet) with moderate and 8 patients (14 feet) with severe. There were 24 patients(37 feet) in DMO group, including 1 male and 23 females, aged from 45 to 62 years old with an average of (52.1±6.8) years old;there were 14 patients (24 feet) with moderate and 10 patients (13 feet) with severe. Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and relative length of the first metatarsal(RLFM) on weight-bearing anteroposterior radiographs before and after operation were compared. American Orthopaedic Foot and Ankle Society (AOFAS) hallux, metatarsal, and interphalangeal joint scores was used for evaluate clinical effects. Weight bearing time and complications were observed. Fivty patients were followed up. The follow-up time in SO group ranged from 12 to 36 months with an average of(20.50±6.22) months and from 16 to 28 months with an avaerge of(19.80±2.44) months in DMO group while there was no significant difference between two groups(P>0.05). All incision healed at stage I, and osteotomy healed at (20.31±3.17) months after operation. One patient occurred hallux adduction deformity, without transferred metatarsalgia;2 patients occurred metastatic metatarsalgia in DMO group. There were no significant difference in HVA, IMA, DMAA, and AOFAS scores between two groups(P>0.05) before and after operation. There was no significant difference in RLFM between two groups(P>0.05), while had significant difference in RLFM between two groups at final follow-up (P<0.05). Partial weight-bearing time and full weight-bearing time in SO group were significantly earlier than those in DMO group (P<0.05). Both of Scarf osteotomy and the first metatarsal biplane osteotomy could effectively treat moderate to severe hallux valgus deformity, with similar imaging and clinical evaluation. However, the relative length of the first metatarsal bone in SO group was longer than that in DMO group after operation, and the time of weight bearing in Scarf osteotomy is earlier than that of double metatarsal osteotomy of the first metatarsal.

Rotating Scarf osteotomy in treating hallux valgus combined with the first metatarsal rotation

To explore clinical effect of rotational Scarf osteotomy in treating hallux valgus (HV) with rotation of the first metatarsal bone. From January 2018 to October 2019, 35 patients (40 feet) with HV and rotation deformity of the first metatarsal were treated with rotational Scarf osteotomy, including 5 males and 30 females;aged from 25 to 76 years old with an average of (40.32±5.43) years old. Hallux valgus angle(HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), the first metatarsal length (FML) were observed and compared, American Orthopedic Foot and Ankle Society(AOFAS) of hallux metatarsophalangeal interphalangeal joint score and visual analogue scale (VAS) were used to evaluate functional evaluation. Thirty-five patients(40 feet) were followed up from 12 to 36 months with an average of (14.35±3.62) months. HVA, IMA and DMAA were corrected from (36.32±4.51) °, (14.21±3.22) ° and (28.35±4.32) ° before operation to (14.32±5.71) °, (5.83±3.97) ° and (7.32±2.14) ° after operation respectively (P<0.05). There was no satistical difference in FML before and after operation (P>0.05). AOFAS score and VAS improved from (57.00±4.31) and (6.00±1.21) before operation to (90.31±3.28) and (1.42±0.83) after operation, respectively, and had significant difference(P<0.05);according to AOFAS score, 23 feet got excellent results, 15 feet good and 2 feet fair. Rotational Scarf osteotomy with strong correction and high dimension could effectively correct HV combined with rotation deformity of the first metatarsal bone, improve function of the forefoot, and obtain good clinical results.

Scarf osteotomy combined with soft tissue balance release for severe hallux valgus

To explore clinical effect of Scarf osteotomy combined with soft tissue balance in treating severe hallux valgus. Totally 38 patients(50 feet) with severe hallux valux who underwent Scarf osteotomy combined with soft tissue balance surgery from June 2019 to June 2021 were retrospectively analyzed, aged from 29 to 64 years old with an average of(54.7±6.8) years old; 26 feet on the left side and 24 feet on the right side;the courses of disease ranged from 5 to 23 years with an average of (12.4±3.9) years. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were compared before and after operation, and postoperative complications was observed. American orthopedic foot ankle society(AOFAS) score before operation and final follow-up was used to evaluate recovery of forefoot function, and visual analogue scale (VAS) was used to evaluate pain relief. Thirty-eight patients (50 feet) were followed up from 15 to 23 months with an average of (18.3±3.2) months. Preoperative HVA, IMA and DMAA were (44.61±3.92)°, (18.74±2.51)°, (12.85±2.11)°, and improved to (13.45±2.13)°, (7.83±1.36)°, (7.03±1.39)°at final follow-up, which had statistical differneces(P<0.05). No delayed union or nonunion of osteotomy end, fracture or loosening of internal fixation, hallux varus occurred. VAS and AOFAS score improved from (6.81±2.14), (43.6±8.4)points before operation to (1.97±0.78), (87.6±5.2) points at final follow-up, which had statistical difference(P<0.01). According to AOFAS at final follow-up, 20 feet got excellent result, 28 feet good and 2 feet moderate. Scarf osteotomy combined with soft tissue balance release for severe hallux valgus has good stability and corrective effect, but learning curve and postoperative complications should be paid attention.

Forefoot width correction in patients with hallux valgus after rotational scarf osteotomy

Objective: Our objective was to compare foot width (bony and soft tissues) in radiological images pre- vs. post-corrective scarf osteotomy in patients with hallux valgus. Methods: We retrospectively performed measurements of forefoot width (both bony diameter and total diameter including soft tissues) on anterior posterior standard radiographs of 30 patients, totaling 42 feet, pre- and postoperatively, at three months. These measurements were performed by two evaluators and their reliability was calculated. Results: Radiologically, preoperative mean of the 1-5 metatarsal bony width was 89.30mm (SD ± 5.8), reduced to 80.42mm postoperatively (SD ± 3.5; p&lt;0.001). Regarding the soft tissue width, preoperative mean was 102.45mm (SD ± 6.4) and postoperative, 98.3mm (SD ± 5.1; p&lt;0.001). The interclass correlation coefficient between both observers was excellent in most measurements (range, 0.884-0.973). Conclusion: We report an objective reduction in forefoot width, in both bony and soft tissue diameter, finding means of 8.88 mm (10%) and 4.12mm (4.1%), respectively, after scarf-Akin osteotomy. Level of Evidence IV; Case Series.

Comparison of short-term outcomes after distal metatarsal telescoping osteotomy and scarf osteotomy for hallux valgus in patients with rheumatoid arthritis

PurposeTo compare the clinical and radiographic outcomes of distal metatarsal telescoping osteotomy (DMTO) and scarf osteotomy for hallux valgus (HV) in patients with rheumatoid arthritis (RA). MethodsOverall, 21 feet in 19 patients treated with DMTO and 26 feet in 26 patients treated with scarf osteotomy were retrospectively compared with significantly longer follow-up periods in the former procedure (51.0 months vs. 28.0 months, P < 0.0001). Radiographic measurements of HV-related parameters and the clinical outcomes which were compared using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal joint score (AOFAS score) were obtained preoperatively and at the latest follow-up. A postoperative comparison of the patient-reported outcome measures was performed using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). ResultsBoth the DMTO and scarf procedures improved the AOFAS score and HV-related parameters. The improvement in the AOFAS score and corrective amount of radiographic parameters showed no significant differences between the two groups. The pain and pain-related subscales of the SAFE-Q were significantly better in the DMTO group (86.7 vs. 70.0, P = 0.0009). The operative time for all toes was significantly shorter in the DMTO group (176.0 min vs. 210.0 min, P = 0.0002). No significant differences were observed in the incidence of post-operative complications. ConclusionBoth DMTO and scarf osteotomy demonstrated comparable outcomes for mild-to-severe HV deformities in patients with RA. The DMTO may be considered as an alternative surgical method for HV deformity in patients with RA with the advantages of being an easy technique and having a shorter operative time.

The Incidence of Complications Following Scarf Osteotomy for the Treatment of Hallux Valgus: A Systematic Review With Meta-Analysis

The Scarf osteotomy is a surgical procedure performed to correct a hallux valgus deformity. Multiple studies have supported use of the procedure with favorable outcomes. In contrast, there have been studies showing a significant complication rate with the procedure. Incidence of complications remains underreported in the literature. We performed a systemic review and meta-analysis examining a wide range of reported complications and associated clinical outcomes from the Scarf osteotomy. One hundred and sixteen publications were identified and 25 (21.6%) met our inclusion criteria. A total of 1583 Scarf procedures were included. Weighted mean follow-up was 26.4 months [range 12-168 months]. We found a 5.1% rate of recurrence, 3.5% rate of troughing, 1.0% rate of avascular necrosis, 1.8% rate of nonunion, 2.7% rate of malunion, 2.4% rate of infection, 5.3% rate of complex regional pain syndrome, and 3.4% rate of hallux varus. An average decrease in intermetatarsal angle of 6.3° was observed. No statistical difference was found in outcomes when comparing Scarf versus Scarf with additional procedure performed at time of surgery. To our knowledge, this systematic review and meta-analysis contains the highest number of Scarf procedures analyzed and presents complication rates on multiple adverse outcomes.

Plain Radiographs are Insufficient for Evaluation of First Metatarsal Pronation in Patients Undergoing Surgery for Hallux Valgus

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Previous studies using weight-bearing CT (WBCT) have suggested that up to 30% of patients with hallux valgus may have excessive pronation of the first metatarsal when defined as a metatarsal pronation angle (MPA) of greater than 16 degrees (Najefi et al.). The MPA is calculated on coronal slices of a CT or MRI, but axial imaging is not the norm in the assessment of these patients. It is however unclear how accurate radiographs are at determining pronation. This study aimed to assess the degree of pre-operative first metatarsal pronation in patients undergoing surgery for hallux valgus using radiographs and WBCT. Methods: This was a retrospective review of patients undergoing scarf osteotomy for hallux valgus correction. Patients were included if they had both plain radiographs and WBCT. Patients were excluded if they had any prior surgery to the foot in question. Pre-operative weightbearing plain radiographs of the foot were analyzed and the classification by Okuda et al. was used to determine if pronation was present using the shape of the lateral edge of first metatarsal head. Pre-operative WBCTs were reviewed and MPA calculated. Twenty-two feet were included. Results: In total 10 feet (45.5%) had an ‘angular’ first metatarsal head, 9 (40.9%) had an ‘intermediate’ head shape, and 3 (13.6%) had a ‘round’ head on plain radiographic assessment. The overall mean MPA was 16.25 degrees (range 2.1-30), and 12 (54.5%) feet had an MPA of greater than 16 degrees (excessively pronated). There was a strong correlation between increasing MPA and increasing roundness of the metatarsal head (Eta = 0.952). The mean MPA was 14.4 degrees in the angular head group, 17.0 degrees in the intermediate group, and 20.1 degrees in the round head group. In the intermediate and round groups 9 feet (75%) had greater pronation than the normal range. By contrast, only 3 (30%) of feet in the round head group had pronation greater than 16 degrees. Conclusion: In this surgical population of hallux valgus patients, the overall prevalence of excessive first metatarsal pronation was greater than in general cohorts of hallux valgus patients. Patients with intermediate and round shaped heads on plain radiographs tended to have greater first metatarsal pronation than those with angular shaped heads, although the correlation was not perfect. This suggests that plain radiographic assessment of metatarsal rotation may not be accurate as there may be discrepancies due to changes in foot position or angle of beam while acquiring the radiographs. Although further work is still required to determine whether there is clinical benefit from addressing the pronation, axial imaging (such as with WBCT) may be useful in the intermediate and round groups for accurate assessment of pronation and to determine if it is significant. This may be especially relevant in surgical candidates in whom osteotomies such as a scarf are being considered, where pronation cannot be addressed.

Modified scarf osteotomy for hallux valgus: From a finite element model to clinical results.

Finite element (FE) analysis and clinical follow-up were used to evaluate the efficacy of modified scarf osteotomy for moderate-to-severe hallux valgus (HV). We retrospectively evaluated 42 patients (44 feet) who underwent modified rotational scarf osteotomy for moderate-to-severe HV at our institution between January 2010 and January 2019. Radiological indicators and subjective scores were recorded at different time points. To compare the results and elemental characteristics, a FE model of the metatarsophalangeal (MTP) joint that included anatomically realistic geometrical and structural characteristics was built. The biomechanical features and correction differences in dynamic loads as well as the incidence of troughing were estimated. Both the hallux valgus angle (HVA) and intermetatarsal angle (IMA) showed significant improvement 6weeks postoperatively (p < 0.05); additionally, the HVA increased from 6weeks postoperatively to the last follow-up, while the IMA showed no significant changes (p > 0.05). The subjective scores significantly improved from the preoperative period to the last follow-up. The percentages of troughing and recurrence were remarkably low in our pilot study because of the innate stability of the modified rotated fixation. Our preliminary findings suggest that modified rotational scarf osteotomy offers sufficient stability, correct HV deformity effectively, and good clinical outcomes for moderate to severe HV.

Hallux valgus with second metatarsalgia: Is second metatarsal Weil osteotomy necessary?

BackgroundThe role of concomitant Weil osteotomy to address second toe metatarsalgia during hallux valgus correction is unclear. We aimed to critically analyse outcomes of an additional Weil osteotomy versus isolated Scarf osteotomy.in the management of hallux valgus and second metatarsalgia. MethodsPatients with second toe metatarsalgia who underwent first metatarsal Scarf osteotomy for hallux valgus were enrolled retrospectively. Demographics, radiographic measurements and functional outcomes were assessed at baseline, 6-months and 2-years postoperatively. Between-group significance was established with Fisher exact test, Chi-square or Mann-Whitney U test. Within-group changes from baseline were assessed with paired t-test and Wilcoxon signed-rank test. Results48 feet (34 isolated Scarf, 14 concomitant Weil osteotomy) were included. Both cohorts demonstrated significant improvements across all measures of functional outcome. However, patients with additional Weil osteotomy reported poorer short-term outcomes. ConclusionSuperiority of additional Weil osteotomy versus isolated Scarf osteotomy in addressing second toe metatarsalgia or improving functional outcomes was not demonstrated.

Contribution Ratio of Metatarsal Osteotomy and First Tarsometatarsal Joint Reduction in Moderate to Severe Hallux Valgus Correction.

Hallux valgus is a common foot and ankle disease, for which numerous surgical procedures were introduced. So, understanding the mechanism of deformity reduction is important to select the proper method. Intermetatarsal angle (IMA) determines the severity of hallux valgus, which is influenced by the translated metatarsal head and the reduction of the first tarsometatarsal joint. We hypothesized that both of the mechanisms simultaneously contribute to the correction of IMA. Hallux valgus (70 feet) operated with a Scarf osteotomy with the Akin procedure were reviewed. Hallux valgus angle (HVA), IMA (mechanical and anatomical), hallux valgus interphalangeal angle (HVIP), distal metatarsal articular angle (DMAA), and sesamoid position were checked. The ratio of contributions to the IMA changes were calculated and compared. When the individual contributions by metatarsal head translation and first tarsometatarsal joint reduction were compared, metatarsal head translation contributed by 82%, whereas first tarsometatarsal joint reduction contributed by 18%. Both were responsible for mechanical IMA correction. However, IMA change by metatarsal head translation was a major correction mechanism compared to anatomical IMA change by first tarsometatarsal joint reduction.

Modified Scarf Osteotomy with Medial Capsular Interposition Combined with Metatarsal Shortening Offset Osteotomy: A Comparison of Patients with Noninflammatory Arthritis and Rheumatoid Arthritis of the Foot.

Patients who have noninflammatory arthritis of the feet may develop destructive changes on the first metatarsal head and painful dislocation of the metatarsophalangeal (MTP) joint of 1 or more lesser toes. This aim of this study was to compare feet with noninflammatory arthritis and those with rheumatoid arthritis (RA) with respect to the clinical and radiographic outcomes after treatment of these destructive deformities with a modified Scarf osteotomy with medial capsular interposition into the newly formed first MTP joint, combined with metatarsal shortening offset osteotomy. A retrospective observational study of 93 feet (31 with noninflammatory arthritis and 62 with RA) was performed. Hallux and lesser-toe scores on the Japanese Society for Surgery of the Foot (JSSF) scoring system, a self-administered foot evaluation questionnaire (SAFE-Q), and preoperative and postoperative radiographic parameters were evaluated. There were significant improvements at the time of the final follow-up in the mean scores on the hallux and lesser-toe scales of the JSSF system and in the SAFE-Q score. The postoperative JSSF lesser-toes function score was better for the feet with noninflammatory arthritis feet than the feet with RA. There was no significant difference in the hallux valgus angle (HVA) between 1 month postoperatively and the final follow-up for both groups. Furthermore, the HVA showed a strong correlation between the 1-month and final follow-up values. The combination of the modified Scarf osteotomy with medial capsular interposition and shortening metatarsal offset osteotomy was useful and safe in feet with noninflammatory arthritis. The HVA at 1 month after surgery is useful to predict the HVA within 5 years after surgery. The postoperative clinical score for the lesser toes was better in the feet with noninflammatory arthritis. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Operative Treatment of Adolescent Hallux Valgus

The hallux valgus deformity in pediatric patients is a common pathology with no definitive criteria for surgical treatment. The purpose of this study is to present mid-term postoperative results after surgical treatment of this foot deformity. The study included 43 operated feet in 29 patients, with an average age of 14.31 years. Scarf osteotomy was performed in 23 patients, combined with an Akin osteotomy in 14 of the cases; Chevron osteotomy was performed in seven patients, five patients were treated with the mini tightrope technique, two with the Ludloff osteotomy, and six patients with lateral hemiepiphysiodesis of the first metatarsal. We evaluated the change in angular radiographic parameters and the American Orthopaedic Foot &amp; Ankle Society scale for data analysis. The mean follow-up of the study was 48 ± 33.2 months. The mean preoperative hallux valgus angle showed an average improvement of 30.19° to 12.79° (p &lt; 0.001). Loss of correction of the HVA angle of 20.46° was noted at the time of final follow up (p &gt; 0.05). Favourable correction of the intermetatarsal angle was achieved with improvement of 11.44° preoperatively to 7.35° postoperatively. Significant progression was found for the American Orthopedic Foot &amp; Ankle Society score from 57 points (42–85) before surgery to 80 points (54–100) after surgery. The recurrence rate 6 months after surgery is 30.95% (13 cases). Relapse of the deformity after Scarf osteotomy was observed in nine cases; after mini tight rope technique in three cases, and in one case after Chevron osteotomy. In conclusion we state that the most important factor influencing the outcomes of treatment and postoperative recurrence rate is skeletal maturity. Surgical treatment should be indicated after growth plate fusion. Conservative treatment via orthotic devices is recommended until that time.

Osteotomy "scarf" in the treatment of patients with valgus deformity of the first toe

The use of scarf osteotomy in 9 patients (14 feet) with valgus deformity of great toe was analysed. That technique was showed to provide stable correction of varus deviation of the first metatarsal bone and valgus deformity of the great toe as well as correction of the length of the first metatarsal bone and elimination of its pronator rotation without development of avascular necrosis of the head in postoperative period. Rigid fixation of bone fragments provides the possibility of early activization and rehabilitation of patients.

Distal chevron osteotomy versus different operative procedures for hallux valgus correction: a meta-analysis

IntroductionDistal chevron osteotomy is commonly used for the operative treatment of hallux valgus (HV). However, there are several operative procedures that can be used to treat HV. The aim of this meta-analysis was to compare the efficacy of distal chevron osteotomy with different operative procedures.Materials and methodsA systematic search was conducted using the MEDLINE and EMBASE databases to identify randomized clinical trials (RCTs). The variables were radiological (hallux metatarsal phalangeal angle [HVA] and intermetatarsal angle [IMA]) and clinical (American Orthopaedic Foot & Ankle Society Score [AOFAS]). Heterogeneity was assessed with chi2 and I2 statistics. A random effects model was used for significant heterogeneity. Publication bias was evaluated with funnel plots.ResultsTen studies involving 985 patients were evaluated in the meta-analysis. Distal chevron osteotomy was associated with a mean IMA correction 2.18° greater than the scarf procedure (MD − 2.18; 95% CI − 3.67, − 0.69; p = 0.004; I2 = 0%). In addition, the proximal chevron was associated with a mean IMA correction 1.08° greater than the distal chevron (MD − 1.08; 95% CI − 1.86, − 0.29; p = 0.007; I2 = 0%). The AOFAS assessment showed an overall advantage of 3.2 points in favor of the Lingdren group compared with distal chevron osteotomy (MD 3.20; 95% CI 0.37, 6.04; p = 0.03; I2 = 0%).ConclusionsOur findings indicate that distal chevron osteotomy provides a greater HVA correction than scarf osteotomy, and proximal chevron provides a larger IMA correction than distal chevron osteotomy. Lingdren osteotomy provides a greater AOFAS correction than distal chevron osteotomy.Level of evidenceLevel I, meta-analysis.

Actual tendencies of Hallux Valgus surgical treatment.

The purpose of this study is to evaluate which of the methods selected in patients with moderate or severe hallux valgus a result in a better correction of hallux valgus angle (HVA) and intermetatarsal angle (IMA) in Scarf osteotomy as compared to Chevron osteotomy.&#x0D; Material and methods; In our study, we selected 36 patients, 16 scarf and 20 chevron osteotomies, with all surgical options from skin incision, capsular and bunionectomy to bone reorientation. Deformities of patients were classified as mild, moderate and severe according to clinical and radiological findings. The results were measured using radiographic HVA, IMA and distal metatarsal articular angle (DMAA).&#x0D; Results: No statistical differences were found in HVA, IMA and DMAA between scarf and chevron osteotomy in mild to moderate hallux valgus. In severe hallux valgus, Scarf osteotomy corrected HVA better than Chevron, although this group consisted of twelve patients. Two patients in the Chevron group and three in the Scarf group developed subluxation of the metatarsophalangeal joint.&#x0D; Conclusion: In patients with moderate and severe hallux valgus the results of Scarf and Chevron osteotomy have no specific difference. Change to IMA angle with the subluxation of the first metatarsophalangeal joint some months after operation were the main cause for insufficient correction. We favor the Scarf osteotomy because it is more profitable, with correction of HVA and IMA.

Moderate to Severe Hallux Valgus Deformities. Surgical treatment with SCARF Osteotomy Technique.

Introduction; Many procedures are described in the literature for the surgical management of hallux valgus. There are over 130 surgical procedures described. There is ever rising enthusiasm among orthopedic surgeons regarding diaphyseal osteotomy ever since Burutaran described the procedure in 1973. We report our experience of treating severe cases of Hallux Valgus deformity with a SCARF osteotomy at the last three years follow-up, at patients diagnosed and operated in the University Hospital of Trauma, from January 2015 - February 2018. The technique we are presenting, provides the correction of moderate to severe hallux valgus deformities.&#x0D; Material and Methods: Correction of hallux valgus deformities was achieved using a Z step osteotomy cut to realign the first metatarsal bone. A retrospective analysis was undertaken in 38 consecutive patients (54 feet). All results were analyzed by clinical examination, a questionnaire including the AOFAS forefoot score, modified, and plain roentgenograms.&#x0D; Results: Hallux valgus and intermetatarsal angle improved at mean 19.6° and 6.9°, respectively. Mean forefoot score improved from 50.1 to 91 points out of 100 possible points. Satisfactory healing time was expressed by an average return back to their attitude of 6-12 weeks, without including physiotherapy. Persistence or recurrence of hallux valgus was seen in 3 patients (8%). The complication rate was 5.4% including superficial wound infection, atrophy of the muscles, traumatic dislocation of the distal fragment.&#x0D; Conclusion: Scarf osteotomy is a powerful and versatile procedure to correct hallux valgus deformity, and provides a predictable and satisfying result. Scarfs are not considered as a single osteotomy but as a combination of several procedures and displacement in several planes are possible.

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

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.

Pes Planus Does Not Negatively Affect Clinical Outcomes after Hallux Valgus Surgery

Category:Bunion; Hindfoot; Midfoot/Forefoot; OtherIntroduction/Purpose:Pes planus is associated with hallux valgus development. Increased forefoot abduction and pressure through the hallux during the heel-rise phase of the gait in a pes planus foot is believed to contribute to hallux valgus formation. These abnormal forces through the hallux may result in poorer healing and more residual pain after surgical correction. We investigated if patients with increasing severity of pes planus presented with more severe hallux valgus deformity and whether these patients had more residual pain and poorer function following hallux valgus surgery.Methods:We evaluated 191 consecutive cases of hallux valgus surgery with Scarf osteotomy as the primary procedure. American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, visual analog scale (VAS), Short Form-36 physical component summary (SF-36 PCS), mental component summary (SF-36 MCS) and a satisfaction questionnaire were assessed at baseline, 6 months and 24 months postoperatively. Pes planus angles measured were the talonavicular coverage angle (TNCA), lateral talus-first metatarsal angle (Meary's angle) and lateral talocalcaneal angle (LTCA). The cohort was stratified into controls (0°-4.0°), mild (4.1°-14.9°), moderate (15.0°-30.0°) and severe (>30.0°) pes planus groups according to Meary's angle. Clinical outcomes were compared among the groups. Multiple regression was used to determine association between pes planus angles and outcomes.Results:There were 78 controls, 95 mild, 18 moderate and no severe cases of pes planus. Meary's angle was independently associated with preoperative HVA (beta 0.408, 95% CI 0.104-0.712, P =.009). Patients with mild and moderate pes planus had significantly greater preoperative HVA (P <.001) compared to controls. Pes planus angles were not associated with pre- or postoperative VAS, AOFAS score, SF-36 PCS or SF-36 MCS. Among controls, mild and moderate pes planus groups, there were no significant differences in pre- or postoperative clinical scores (Table 1), and satisfaction was 84.6, 80.0% and 77.8%, respectively (P =.667).Conclusion:Patients with increasing severity of pes planus presented with greater severity of hallux valgus deformity. However, patients with pes planus had similar pre- and postoperative clinical outcomes and satisfaction after hallux valgus surgery in comparison to patients with neutral foot arches.

Correction of hallux abducto valgus by scarf osteotomy. A ten-year retrospective multicentre review of patient reported outcomes shows high satisfaction rates with podiatric surgery

BackgroundCorrective surgery for hallux abducto valgus is one of the most performed elective procedures in foot and ankle practice. Numerous methods of surgical correction have been reported within the literature, with varying clinical and patient reported outcomes. This study reviews the patient experience and outcomes in five podiatric surgery centres using the scarf diaphyseal osteotomy.MethodPatient reported outcome measures (PROMs) were captured using the Patient Satisfaction Questionnaire 10 (PSQ-10), part of the PASCOM-10 podiatric surgery audit tool. PROMs were collated across five hospital sites over a 10-year period.ResultsOf 1351 patients reported during the period, 1189 had complete retrospective data. The most common patient aim of surgery was ‘no/less pain’ reported in 70% of patients. 96.8% of patients reported their original foot complaint as ‘better’ or ‘much better’ after surgery. 92.8% of patients reported their expectations had been met with 96.6% reporting they would have surgery again under the same conditions. 98.5% of patients noted that the risks, complications, and expectations had been discussed prior to surgery. The most common complication was metatarsal fracture (4.6%).ConclusionThe scarf osteotomy (with or without an Akin phalangeal osteotomy) consistently showed high patient satisfaction with low complication rates using PSQ-10 and this information can be used as part of the pre-operative consenting process. Patient expectations for surgery were often achieved, which may be attributed to the pre-operative work up of the patient. Further investigation into this correlation is suggested.Level of clinical evidenceIV (retrospective review).