Scarf Osteotomy For Hallux Valgus Research Articles

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.

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.

Hallux Valgus Pronation Correction by Scarf Osteotomy: Prospective Case Series with WB-CT Scan

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:Hallux valgus is one of the most prevalent foot deformities. Coronal metatarsal rotation (pronation) has been recognized as a key element in hallux valgus deformity and an important prognostic factor for recurrence. New surgical techniques have been developed in order to specifically address pronation deformity but tend to be technically demanding. With the advent of weight bearing CT (WBCT), accurate pronation measurement has improved. Deformity correction by means of metatarsal osteotomies has been an effective way to correct transverse plane deformity but its capacity for pronation correction is not well established. Purpose: Assess transverse and coronal plane rotation deformity correction by WBCT in hallux valgus patients after scarf osteotomy.Methods:We prospectively analyzed hallux valgus deformity in patients who underwent Scarf osteotomy for symptomatic hallux valgus with preoperative and at least 3 month postoperative WBCT for comparison. Intermetatarsal angle (IMA), hallux valgus angle (HVA) and alpha angle (AA) for first metatarsal rotation (pronation) was measured by 3 different observers. The intraclass correlation was determined. Pre and postoperative measurement change was established by T-test and Wilcoxon for related samples.Results:40 feet in 25 patients were included. The interclass correlation between observers was 0.9 for AA (pronation), 0.92 for IMA and 0.95 for HVA in preoperative evaluation and 0.94 for AA, 0.65 for IMA and 0.82 for HVA in postoperative evaluation. The mean preoperative and postoperative AA of the first metatarsal was 8.9 degrees (range -8.83-24,40, SD 6.8) and 6.3 degrees (range -10.7-28.4, SD 8.3) respectively, resulting in a significant first ray pronation change of -2.5 degrees (P =.006). The media preoperative and postoperative IMA was 13.1 degrees (SD 2.9) and 4.9 degrees (SD 2.0) respectively, demonstrating a significant change (P <.001). The media preoperative and postoperative HVA was 25 degrees (SD 6.7) and 5.9 degrees (SD 4.2) respectively, demonstrating a significant change (P <.001)Conclusion:The Scarf osteotomy for hallux valgus deformity has a significant power to correct both transverse and coronal plane (pronation) deformity.

Influence of sesamoid position after scarf osteotomy for hallux valgus on patient-reported outcome. A prospective cohor study

BackgroundThe objective was to evaluate the influence of the postoperative sesamoid position as measured with conventional radiographs on the patient-reported outcome after scarf osteotomy. The hypothesis was that incomplete reduction of the sesamoid would result in a decreased functional outcome. MethodsEighty-two patients who underwent scarf osteotomy for hallux valgus were prospectively assessed for up to two postoperative years. The Self-Reported Foot and Ankle Score (SEFAS) was used to assess the quality of life, and the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS) for the functional outcome. A visual analogue scale (VAS) assessed pain, and Likert scale for patient satisfaction. Radiologically, hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), and sesamoid position were analyzed. According to the final sesamoid position, patients were classified as normal position (48 patients) and outlier position (34 patients). A power analysis, conventional and logistic regression statistical analysis were performed. ResultsAt the final follow-up, significant improvements in all clinical scores were observed for both groups (p = 0.001) with no significant difference in AOFAS score (p = 0.413), but SEFAS score (p = 0.023), VAS-pain (p = 0.006), and satisfaction (p = 0.014) were significantly better in the normal group than in the outlier group. There were significant differences between groups in final HVA (p = 0.042) and IMA (p = 0.040). In multivariate analysis, only lower VAS-pain score (OR 0.4, 95% CI 0.2–0.6; p = 0.039) and normal sesamoid position (OR 2.4, 95% CI 1.6–3.2; p = 0.012) were significant predictor of patient satisfaction. ConclusionAt two postoperative years, normal sesamoid position as measured on weight-bearing radiographs was associated with lower pain and better patient satisfaction in patients underwent scarf osteotomy for moderate to severe hallux valgus.

Modified Lapidus vs Scarf Osteotomy Outcomes for Treatment of Hallux Valgus Deformity.

The Lapidus procedure and scarf osteotomy are indicated for the operative treatment of hallux valgus; however, no prior studies have compared outcomes between the procedures. The aim of this study was to compare clinical and radiographic outcomes between patients with symptomatic hallux valgus treated with the modified Lapidus procedure versus scarf osteotomy. This retrospective cohort study included patients treated by 1 of 7 fellowship-trained foot and ankle surgeons. Inclusion criteria were age older than 18 years, primary modified Lapidus procedure or scarf osteotomy for hallux valgus, minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and minimum 3-month postoperative radiographs. Revision cases were excluded. Clinical outcomes were assessed using 6 PROMIS domains. Pre- and postoperative radiographic parameters were measured on anteroposterior (AP) and lateral weightbearing radiographs. Statistical analysis utilized targeted minimum-loss estimation (TMLE) to control for confounders. A total of 136 patients (73 Lapidus, 63 scarf) with an average of 17.8 months of follow-up were included in this study. There was significant improvement in PROMIS physical function scores in the modified Lapidus (mean change, 5.25; P < .01) and scarf osteotomy (mean change, 5.50; P < .01) cohorts, with no significant differences between the 2 groups (P = .85). After controlling for bunion severity, the probability of having a normal postoperative intermetatarsal angle (IMA; <9 degrees) was 25% lower (P = .04) with the scarf osteotomy compared with the Lapidus procedure. Although the modified Lapidus procedure led to a higher probability of achieving a normal IMA, both procedures yielded similar improvements in 1-year patient-reported outcome measures. Level III, retrospective cohort.

Impact of pes planus on clinical outcomes of hallux valgus surgery

BackgroundPes planus is associated with hallux valgus development. This study evaluated the impact of pes planus on clinical outcomes following hallux valgus surgery. Methods191 patients underwent Scarf osteotomy for hallux valgus. Pes planus angles including talonavicular coverage angle, lateral talus-first metatarsal angle (Meary’s angle) and lateral talocalcaneal angle were measured. The cohort was stratified into control (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 at baseline, 6 months and 24 months. ResultsThere were 78 controls, 95 mild and 18 moderate cases of pes planus. Meary’s angle was independently associated with preoperative hallux valgus angle. Pes planus angles were not associated with pain, AOFAS, SF-36 physical or mental scores. All three groups had similar clinical outcomes and patient satisfaction. ConclusionCompared to patients with neutral foot arches, those with pes planus presented with more severe hallux valgus deformity but had similar clinical outcomes following surgical correction.

Correcting the Hallux Valgus Deformity: A Comparison Between Modified Lapidus Procedure and Scarf Osteotomy

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:Lapidus procedure and Scarf osteotomy are indicated for treatment of mild to moderate hallux valgus. Advantages of modified Lapidus procedure include ability to address severe deformity, first tarsometatarsal arthritis, and first ray hypermobility. Advantages of Scarf osteotomy include greater correction of the distal metatarsal articular angle (DMAA) and greater fixation stability than other techniques. Both procedures have shown good radiographic and clinical outcomes; however, no prior studies have compared these outcomes between the procedures. The aim of this study was to compare clinical and radiographic outcomes between patients with hallux valgus treated with the modified Lapidus procedure or Scarf osteotomy.Methods:This retrospective cohort study included patients treated by one of seven fellowship-trained foot and ankle surgeons were identified. Inclusion criteria were age greater than 18 years, primary modified Lapidus procedure or Scarf osteotomy for hallux valgus, minimum 1-year postoperative PROMIS scores, and minimum 3-month postoperative radiographs. Revision cases were excluded. Clinical outcomes were assessed using six PROMIS domains: Pain Interference, Pain Intensity, Physical Function, Global Mental Health, Global Physical Health, and Depression. Pre- and postoperative radiographic parameters were measured on AP (HVA, IMA, DMAA, tibial sesamoid position), and lateral (talo-1st-metatarsal angle (Meary’s), Horton index, Seiberg index, sagittal IMA) x-rays. Statistical analysis utilized targeted maximum likelihood estimation controls for confounding of bunion severity by including covariates for baseline HVA and IMA. Statistics were also analyzed in a restricted cohort of mild to moderate severity bunions (HVA<40 and IMA<16; n=57 each). Complications including repeat surgeries, recurrence of deformity, and malunion/nonunion were recorded.Results:136 patients (73 Lapidus, 63 Scarf) with average 17.8 month follow-up constituted our study. Both groups demonstrated significant improvement in Global Physical Health, Global Mental Health, and Physical Function, with patients in the Lapidus group showing a significantly greater improvement of 3.6 points (p=0.01) compared to Scarf. After controlling for bunion severity, the probability of having normal postoperative IMA (<10 ) was 17% lower (p<0.001) with Scarf compared to Lapidus. This finding was consistent in the restricted cohort of mild to moderate severity bunions. Lapidus group demonstrated significantly greater correction in Meary’s angle, Seiberg index, and sagittal IMA. Complications in the Lapidus group included one nonunion, three symptomatic implants, two hallux varus. The Scarf group had one reoperative cheilectomy and one second metatarsal stress fracture.Conclusion:This is the first study to compare both radiographic and patient-reported outcomes between Lapidus procedure and Scarf osteotomy for correction of hallux valgus deformity. While both procedures yielded improvements in outcomes, results suggest that the probability of having a normal postoperative IMA is greater with Lapidus procedure, even when adjusted for severity of deformity. In addition, greater correction reflected in sagittal measurements may further support the role of rotational correction in the Lapidus procedure.

Return to Physical Activities after Scarf Osteotomy for Hallux Valgus.

Scarf osteotomy is an effective method of surgical treatment of hallux valgus. The final im-pact of the procedure on patients' physical activity has not been assessed so far. Our goals were to evaluate sports and physical activities in patients following the Scarf osteotomy and to compare these with clinical outcomes. The study included 79 patients who were treated for hallux valgus with a Scarf osteotomy in 2015-2016. The average age in the examined group at the time of surgery was 55.43 (± 11.97) years, while the follow-up was on average 3.13 (± 0.42) years. Physical activity was measured using the UCLA - Activity Score and Author's Sport Specific Questionnaire. Clinical outcomes were evaluated with the Ame-rican Orthopedic Foot and Ankle Score (AOFAS HMI) and compared to sports outcomes. After the procedure, the frequency of undertaking physical activity increased by about 21% (p = 0.0005) and the time spent by patients during the week on sports (minutes per week) increase by about 19% (p = 0.005). The result of the UCLA - Activity Score after surgery increased by an average of about 4.7% (p = 0.016). The average satisfaction with the result of the surgery was 8.2 (1-10 scale). The majority of patients (67%) were able to maintain the amount of physical activity after the surgery and few patients (24%) were able to increase this amount. The study suggests that Scarf osteotomy has a positive effect on the ability of patients with hallux valgus to return to sport and physical activity.

Chevron osteotomy versus Scarf osteotomy for the efficacy of radiographic and clinical in moderate and severe hallux valgus:a systematic review

To evaluate efficacy of radiographic and clinical of Chevron osteotomy versus Scarf osteotomy for hallux valgus at moderate and severe degree. Randomized controlled trial (RCT) about Chevron and Scarf osteotomy for hallux valgus, in PubMed, Embase, Cochrane Library, CBM, CNKI, Wanfang Data were searched by computer from establishing database to June 2018. According to inclusion and exclusion criteria, two researchers independently screened the literatures, evaluated risk of bias and extracted related observation index, RevMan 5.3.5 software was used to perform Meta-analysis. Postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), AOFAS score, complications and patients' satisfaction degree between Chevron and Scarf osteotomy. Six RCT literatures were included, involving 507 patients, 92.5% patients were at moderate and severe degree, and 261 patients were performed by Chevron osteotomy and 246 patients were performed by Scarf osteotomy. Meta analysis results showed that Chevron osteotomy was better than Scarf osteotomy in correcting HVA [MD=-1.95, 95%CI(-2.64, -1.27), P<0.000 01]. While there were no statistical differences in IMA [MD=-0.42, 95%CI(-1.04, 0.21), P=0.19], DMAA[MD=0.78, 95%CI(-0.72, 2.29), P=0.31], AOFAS score [MD=2.47, 95%CI(-2.38, 7.33), P=0.32], complications [RR=1.09, 95%CI(0.54, 2.20), P=0.82], and patients' satisfaction degree [RR=1.00, 95%CI(0.96, 1.05), P=0.92]. Chevron osteotomy, which has advantages in simple operation, shorten metatarsal bone, less trauma, was better in correcting HVA of hallux valgus at moderate and severe degree, and had similar effects in IMA, DMAA, AOFAS score, complications and patients' satisfactory degree.

Mechanical Testing of Maximal Shift Scarf Osteotomy with Inside-Out Plating Compared to Classic Scarf Osteotomy With Double Screw Fixation

The purpose of the present study was to biomechanically compare the primary stability of our formerly described inside-out plate fixation to the classic double screw fixation for scarf osteotomy in the treatment of hallux valgus. We performed 20 scarf osteotomies on first metatarsal composite bone models. One half were fixed using a double screw technique and the other half using a locking plate inside-out technique. Using a testing device to simulate the physiologic load, the specimen was loaded until failure, and the load at failure, displacement at failure, and work at failure were recorded. The results were compared between the 2 groups and against the findings from intact sawbones. Compared with the intact bone models, the energy absorption was low for both types of osteotomy fixation. Between the 2 fixation groups, the load at failure was greater for plate fixation, although the difference was not statistically significant (p = .051). However, a statistically significant difference was found between both groups comparing work and displacement at failure (p < .001). In conclusion, the formerly described inside-out plating technique is a biomechanically reasonable alternative to screw fixation because of its primary stability after scarf osteotomy for hallux valgus.

Chevron osteotomy versus scarf osteotomy for hallux valgus correction: A meta-analysis

BackgroundThis study intended to investigate the optimal surgical strategy in hallux valgus (HV), and to provide a basis for clinical treatment of HV. MethodsStudies related to chevron osteotomy and scarf osteotomy for HV were enrolled from online databases. Hallux valgus angle (HVA) was the main outcome variable. Enrolled studies included posttreatment data for intermetatarsal angle (IMA), American Orthopaedic Foot & Ankle Society (AOFAS) score, and complications. A random-effects model was applied for significant heterogeneity. Otherwise, a fixed-effects model was used. Heterogeneity was assessed with Q test and I2 statistics. Publication bias was evaluated with Egger's test. Based on the influence of weighted mean difference values or odds ratios, a sensitivity analysis was performed. ResultsFour studies including 384 subjects were evaluated to determine the optimal surgical strategy for HV. There was no statistically significant difference between chevron and scarf groups for HVA, IMA, AOFAS score, and complication rates. Sensitivity analysis showed good stability. The likelihood of publication bias was small. ConclusionThe effects of chevron osteotomy and scarf osteotomy for HV are comparable. Chevron osteotomy is less technically demanding.

Predicting Treatment Success after Scarf Osteotomy for Hallux Valgus using The American Orthopedic Foot and Ankle Society and Short Form Health Survey Scores

Predicting Treatment Success after Scarf Osteotomy for Hallux Valgus using The American Orthopedic Foot and Ankle Society and Short Form Health Survey Scores

Short Scarf Osteotomy for Hallux Valgus: Short-term and Medium-term Results

ABSTRACT Aim The scarf osteotomy, as popularized by Barouk, is a versatile osteotomy for the correction of moderate and severe hallux valgus deformity. However, this technique requires extensive exposure, fixation, and increased operative time, and is technically demanding. We describe and present our results of a short scarf osteotomy (SSO), which retains all the cuts of a standard scarf but requires a reduced exposure, less metalwork, less operating time, and is more economical. Materials and methods All patients who underwent SSO between January 2010 and December 2012 with minimum follow-up of 12 months were eligible for the study. Preoperative, intraoperative, and postoperative radiographs were available for radiological assessment. Results In this study, 84 patients and 94 feet were included; 90% of patients were satisfied overall, with 83% of patients recommending this surgery to a friend. The hallux valgus angle improved from a preoperative mean of 30.89° (17.4—46.8) to 12° (4—30) postoperatively (p = 0.0001). The intermetatarsal angle improved from a preoperative mean of 15.05° (10.3—21.1) to 7.14° (4—15.1) postoperatively (p = 0.0001). The average sesamoid coverage improved from grade 2.18 (1—3) preoperatively to 0.57 (0—2) postoperatively (p = 0.0001). The average American Orthopedic Foot and Ankle Score improved from 51.26 (32—88) preoperatively to 91.1 (72—100) postoperatively (p = 0.0001). Conclusion We believe that this osteotomy is a novel procedure producing good to excellent results in most cases of hallux valgus. Biologically, the decreased exposure should improve healing and reduce the risk of avascular necrosis. We strongly recommend this osteotomy for most cases of hallux valgus surgery. How to cite this article Dalal R, Rachha R, Leonard D, Chourasia A, Javed S. Short Scarf Osteotomy for Hallux Valgus: Short-term and Medium-term Results. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):14-18.

Troughing after Scarf Osteotomy Leads to Minimal Gait Alterations

We aimed to investigate whether troughing during scarf osteotomy for hallux valgus can be determined using plantar pressure analysis. In order to quantify the foot print area of a patient at 7 and 12 weeks after the surgery, the raw pressure data were exported to two matrixes. Each matrix has the size of the force distribution platform and contains the plantar force data of the patient in gait movement. These large matrixes containing both left and right pressure data were divided in small size matrixes and averaged. The computation was done in Matlab. The matrixes were flipped up in order to have the natural position of the footprint. The two were plotted as contours in Z axis but kept the external contours only. This difference was measured by subtracting the areas of the two contours. The results are typical footprints for left and right legs, at predetermined follow-up points.

The Incidence and Natural History of Forefoot Scar Pain Following Open Hallux Valgus Surgery

Scar symptoms are a recognized complication of forefoot surgery. The aim of our study was to quantify and qualify these symptoms following open Scarf osteotomy for hallux valgus. A total of 125 consecutive patients with a minimum of 1 year's follow-up were questioned, with a response rate of 82%. Four patients were excluded because of superficial wound infections, leaving 98 patients in the study. In all, 30 patients (31%) reported scar symptoms. In this symptomatic group, 8 patients (21%) undertook noninvasive intervention for their symptoms, and the remaining 22 symptomatic patients (79%) did not use any form of intervention for their symptoms. Patients who undertook some sort of intervention had a significantly shorter duration of symptoms (mean = 19 vs 44 weeks; P = .01). The mean duration of symptoms was 27.9 weeks, and mean symptom score was 3 out of 10. At the 1-year follow-up, 95% of patients had no scar symptoms. There was no significant difference in either the preoperative severity of the deformity or the degree of correction achieved between the symptomatic and asymptomatic patients. These results can be used to obtain consent, educate, and reassure patients. We recommend simple noninvasive interventions should patients experience postoperative scar symptoms. Therapeutic, Level IV.

Scarf Osteotomy for Hallux Valgus Deformity

Scarf midshaft metatarsal osteotomy has become increasingly popular as a treatment option for moderate-to-severe hallux valgus deformities because of its great versatility. Numerous studies on Scarf osteotomy have been published. However, no prospective studies were available until 2002. Since then, only short-term follow-up prospective studies have been published. We present the results of a prospective study of 21 patients treated by Scarf osteotomy for hallux valgus with follow-up of 8 years. Between August 1, 1999, and October 31, 1999, 23 patients (23 feet) with moderate-to-severe hallux valgus deformity were included. Clinical (American Orthopaedic Foot and Ankle Society score) and radiologic (hallux valgus angle, first intermetatarsal angle, and sesamoid position) evaluations were performed preoperatively and 1 and 8 years postoperatively. Clinical evaluation showed a significant improvement in the mean forefoot score from 47 to 83 (of a possible 100) at 1 year (P < .001). Radiographic evaluation showed significant improvement in the hallux valgus angle (mean improvement, 19 degrees ; P < .001) and in the intermetatarsal angle (mean improvement, 6 degrees ; P < .001). These clinical and radiographic results were maintained at the final evaluation 8 years postoperatively. Scarf osteotomy tends to provide predictable and sustainable correction of moderate-to-severe hallux valgus deformities.

Scarf osteotomy for the treatment of hallux valgus deformity: a review of 26 cases

The aim of this study was to evaluate Scarf osteotomy, associated or not with phalangeal osteotomy, for the treatment of hallux valgus, and to determine its limits. We performed a retrospective review of 24 patients (26 feet) who had been treated by Scarf osteotomy for hallux valgus between July 2000 and June 2005 in the orthopedic traumatology department of University Hospital Centre (CHU) in Casablanca. The results were carefully evaluated according to Groulier scores. The mean follow-up time was 2 years and 6 months. The average age at surgery was 37.5 and the majority of patients were female; 79.2% of the patients were satisfied or very satisfied. According to the Groulier scores, 65.4% of the outcomes were good or very good. There was a correlation between the treatment satisfaction index and clinical symptoms (metatarsalgia and stiff hallux). There was a statistically significant decrease in hallux valgus (36.3 to 16.3°), metatarsus varus (15.8 to 7.3°) and distal metatarsus articular angle (28.5 to 14.8°). The cut-off limits for deformations difficult to correct satisfactorily were MP > 36°, MV angle > 16° and AADM > 14°. Performing a phalangeal osteotomy in addition can improve the radiological results, but it is very difficult to obtain satisfactory correction if the initial deformations are severe, even if associated with Scarf osteotomy.

Pedographic, Clinical, and Functional Outcome after Scarf Osteotomy

The aim of this study was to investigate whether a Scarf osteotomy for hallux valgus correction achieves a good functional restoration with pain reduction, improved mobility, and hallux loading. Therefore, we prospectively studied 32 patients who had a Scarf osteotomy for unilateral hallux valgus. We performed clinical, radiographic, and pedographic evaluations after a mean followup of 33 months to assess clinical and functional outcomes. The mean postoperative American Orthopaedic Foot and Ankle Society score was 89 points. The hallux valgus angle improved from 32.5 degrees to 6.2 degrees , and the intermetatarsal angle improved from 15.5 degrees to 6.6 degrees . The postoperative pedographic patterns showed that the maximum force and impulse decreased under the lateral forefoot and increased under the medial forefoot and hallux. The first ray became more important in the roll-over process. There was a moderate relationship between satisfaction and postoperative hallux valgus angle. The Scarf osteotomy improved the pain situation, the walking capacity, and led to an improved contribution of the hallux in the roll-over process. Therefore, this surgical procedure restores forefoot function and normalizes plantar pressure patterns.

Druckverteilungsmessung nach Scarf-Osteotomie bei Hallux valgus

This study evaluates the pressure distribution, the radiological and clinical results in patients before surgery and 6 months after scarf osteotomy for hallux valgus. 29 patients were examined before surgery and 6 months after surgery for symptomatic hallux valgus. Pedographic analysis was performed by dividing the footprint of the patients into 8 regions of interest. For each region the maximum mean pressure and the peak pressure were evaluated. Moreover, clinicofunctional results (AOFAS score) and radiological results were evaluated. 6 months postoperatively, maximum mean pressure increased significantly under the medial forefoot where as the peak pressure in this region revealed indifferent results. Significant improvement of clinicofunctional results and a significant reduction of the intermetatarsal and metatarsophalangeal angle could be seen. These results confirm the clinical and radiological findings of other studies, but this study shows for the first time an increase of pressure under the first ray of the foot after hallux valgus surgery and an adaptation to the pressure distribution of normal feet.