Scarf Osteotomy Research Articles

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.

Magnesium-based bioabsorbable screw fixation for hallux valgus surgery – A suitable alternative to metallic implants

BackgroundThe primary aim of this pilot study was to prospectively evaluate outcomes of the MgYREZr bioabsorbable screw in the setting of hallux valgus corrective surgery. The secondary aim was to compare the outcomes against a control group treated with conventional titanium screws. MethodsA consecutive series of patients with hallux valgus deformity (n=24) underwent forefoot reconstruction surgery with a scarf osteotomy to the first metatarsal using MgYREZr screws. Functional scores, radiological outcomes, and complication profile were recorded over 12 months. Results were compared against a control group of patients (n=69) using titanium alloy screws. ResultsAt 1-year post-operative, both functional and radiological outcomes showed significant improvements. Compared to the control group, there was no significant difference in functional outcomes, yet radiological improvements were significantly better in the control group. ConclusionsThe MgYREZr bioabsorbable screw is a suitable alternative to titanium alloy screws for hallux valgus corrective surgery.

Preoperative Mental Health Score and Postoperative Outcome After Hallux Valgus Surgery.

Preoperative mental health status as a predictor of operative outcome has been a growing area of interest. In this paper, the correlation between preoperative mental health status and postoperative functional outcome following scarf osteotomy for hallux valgus correction was explored. Parameters were tabulated preoperatively and postoperatively at a minimum of 1-year follow-up. They included the Short Form 36 (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) measurements and the visual analog score (VAS) to quantify pain. SF-36 mental component summary (MCS) score was used as a surrogate for patient's mental health status. Seventy-six consecutive cases were analyzed at a minimum of 1-year follow-up. There were significant improvements in all 8 domains of the SF-36, with the mean MCS score increasing from 52.3 ± 7.6 preoperatively to 55.7 ± 6.8 postoperatively. Preoperative MCS scores were not correlated to changes in AOFAS score, PCS score, VAS pain score, HVA or IMA. Preoperative MCS was observed to be correlated to postoperative AOFAS ( r = 0.381, P = .001) and PCS score ( r = 0.315, P = .006). Patients with a preoperative MCS score ⩾50 had a statistically higher postoperative AOFAS and PCS score than patients with MCS score <50. There was no correlation between preoperative MCS scores and improvements in radiologic parameters. There was also no correlation between the improvements in radiologic parameters and improvements in both the AOFAS and VAS pain scores. Preoperative mental health (as measured by the MCS score) was only correlated to postoperative functional outcome (as measured by the postoperative AOFAS and PCS score), but not other postoperative outcomes (VAS pain score, radiologic parameters). Level III, comparative study.

Increased intermetatarsal angle of the proximal fragment after modified scarf osteotomy

Objective: Hypermobility of the first ray can explain the correlation between the instability of this joint and the progression and recurrence of hallux valgus. The modified Scarf osteotomy allows rotation of the distal fragment, in addition to medial traction of the proximal fragment. We believe that if the deformity is corrected by maximizing the instability of the metatarsal-cuneiform joint so that medial inclination of the first metatarsal is no longer possible, then the risk of recurrence in the long term may be lower. Methods: The pre- and postoperative radiographs of 32 modified Scarf osteotomy cases were analysed. We compared already established angles for the radiographic analysis of the deformity, in addition to the creation of two new parameters for the evaluation of the varisation capacity of the osteotomy proximal stump. Results: There was correction of hallux valgus and the intermetatarsal angle, in addition to correction of the first metatarsal head in relation to the sesamoids. We found an increase of the medial inclination of the osteotomy proximal fragment, measured using the parameters proposed by the authors. Conclusion: The modified Scarf osteotomy corrects the conventional hallux valgus parameters, is able to increase the varisation of the proximal fragment of the first metatarsal, and may lead to greater instability in the first metatarsal-cuneiform joint, which, in our opinion, would lead to less chance of recurrence in the medium and long term. Level of Evidence IV; Diagnostic Studies.

Results of Scarf Osteotomy Without Implant Fixation in the Treatment of Hallux Valgus.

The main goal of the study was to evaluate the costs, clinical and radiologic results, and complications of hallux valgus surgery using scarf osteotomy, depending on the type of fixation (with or without screws). We evaluated 169 patients who underwent scarf osteotomy between January 2013 and August 2016. The patients were separated into 3 groups depending on the type of stabilization: A, 2 screws (50 patients); B, modified with 1 screw (55 patients); C, modified without implant (64 patients). We assessed duration of surgery, additional procedures, pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA) on anteroposterior and lateral foot weightbearing radiographs, the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale for the clinical assessment preoperatively and at the 12-month follow-up. We recorded all the complications and compared the costs between the groups. Both the average HVA (A: from 33.7 to 12.6 degrees, B: 35.0 to 13.2 degrees, C: 34.7 to 12.4 degrees) and IMA (A: from 14.9 to 7.5 degrees, B: 15.2 to 6.9 degrees, C: 15.5 to 7.8 degrees) decreased in all groups without significant intergroup differences. The average AOFAS score improved in all the groups (A: from 40 to 88 points, B: 38 to 89 points, C: 42 to 91 points). A similar complication rate was observed (A: 9%, B: 10%, C: 11%). In group C, we noted a shorter time of surgery, and the procedure was the most cost-effective. Scarf osteotomy without implant stabilization was faster and cost-effective and gave comparable results. It was technically demanding and required patient compliance. Level III, retrospective comparative study.

A Comparative Study of Mini-Scarf Versus Standard Scarf Osteotomy for Hallux Valgus Correction

Scarf osteotomy is widely used for hallux valgus treatment. More recently, a trend has begun toward the use of minimally invasive techniques, including the mini-scarf osteotomy, in which the diaphyseal cut is shortened. We compared the mini-scarf and traditional scarf osteotomy to determine whether the mini-scarf osteotomy is as effective as the scarf osteotomy in correcting mild to moderate hallux valgus and improving clinical function. We reviewed the cases of 37 consecutive patients during a 2-year period. A total of 21 (56.8%) patients had undergone scarf osteotomy and 16 (43.2%) had undergone mini-scarf osteotomy. The intermetatarsal, hallux valgus, and distal metatarsal articular angles and medial sesamoid position of the 2 groups were measured at 12 weeks postoperatively. The Manchester Oxford Foot Questionnaire scores and patient satisfaction were recorded at 28 months postoperatively. All radiologic parameters and Manchester Oxford Foot Questionnaire scores had significantly improved in both groups (p < .05 and p < .01 for mini-scarf and scarf, respectively). The medial sesamoid position had improved in all patients, with similar satisfaction between the 2 procedures (p = .43). The results of the present study have shown that the mini-scarf osteotomy for mild to moderate hallux valgus is as effective as the standard approach, with the potential benefit of a smaller scar and less soft tissue disruption.

First Metatarsal Pronation, Distal metatarsal articular angle and sesamoid reduction after Modified scarf osteotomy with single screw fixation

Category: Bunion Introduction/Purpose: Scarf osteotomy is a very popular procedure to hallux valgus surgical correction. No literature reported the correction of rotation of first metatarsal after a Scarf osteotomy. First metatarsal rotation correction is important for better results. A retrospective research shows that the modified single screw scarf osteotomy was powerful procedure to correct the rotation. Methods: We study 20 patients, 27 feet. All patients were hallux valgus and a modified scarf osteotomy was used for correction. Weight bearing radiographs of anteroposterior view and weight bearing sesamoid axis view were recorded. A retrospective review with patient follow-up for 3 months compared with the parameters before the surgery. All the data is analyzed with SPSS. Results: The radiographs measured and IMA, HVA, DMAA, first metatarsal rotation angle, the sesamoid grading from the AP view and sesamoid axis view has a significant difference between the before and the after follow-up. Conclusion: The modified single screw scarf osteotomy has an ability to change the rotation of first metatarsal. It is more powerful osteotomy than traditional scarf.

Proximal fragment intermetatarsal angle (PFIA) increases after SCARF osteotomy

Category: Bunion Introduction/Purpose: Instability of the joint between the medial cuneiform and the first metatarsal is considered as one of the progression factors of Hallux valgus and its recurrence in some cases. We believe that we must increase the intermetatarsal angle of the proximal fragment during the correction by the SCARF osteotomy, seeking the greater degree of instability of this joint. Doing that, we can prevent further varus displacement, as we have reached the greater degree of instability. The purpose of this study was to evaluate if the SCARF osteotomy is able to increase the varus position of the base of the first metatarsal. Methods: This is a retrospective study with 32 patients with mild, moderate and severe hallux valgus, who were submitted to surgical treatment by the SCARF technique. All patients were operated by the same surgeon. Anteroposterior radiographs of the loaded foot were analyzed in the pre and postoperative (3 months) moments. We developed two measures to evaluate the position of the base of the first metatarsal: The Proximal Fragment Intermetatarsal Angle (PFIA), and the distance between the lateral cortex of the first metatarsal and the medial cortex of the second metatarsal (3 cm from the base of the first metatarsal). All measurements were made with a virtual ruler on magnified digital images and rounded to the nearest 0.1 mm. A 95% confidence interval was considered for statistical significant results (p&lt;0,05). Results: The mean age of the sample was 44 years, with a predominance of females (62%). The mean pre-operative intermetatarsal angle was 14.9°, while in the postoperative period it was 5.2°, showing that there was correction of the metatarsal positioning. However, the PFIA increased to 17.8° at the post-operative period (p&lt;0,05), showing a greater instability of the first metatarsal cuneiform joint, as the base of the first metatarsal was positioned in a more varus condition. In addition, we observed that there was an increase in the distance between the base of the first metatarsus and the second metatarsus after the surgical procedure, from 13.7 to 16 millimeters (p&lt;0,05). Conclusion: We concluded that the SCARF osteotomy is able to increase the varus position of the base of the first metatarsal, leading to more instability at the first metatarsal cuneiform joint, and, in our opinion, less chance of recurrence in the long-term. A prospective and long-term is needed to prove this statement.

Scarf and Weil osteotomy for symptomatic hallux valgus does not fully remove second toe residual metatarsalgia

Category: Bunion Introduction/Purpose: Patients with hallux valgus (HV) often experience concurrent second toe metatarsalgia due to altered forefoot biomechanics. Additional second toe Weil osteotomy has been performed to reduce transfer metatarsalgia as some studies have highlighted the presence of second toe pain after isolated HV correction. 1, 2 There is a paucity of literature evaluating residual second toe pain after these procedures . We hypothesize that combined Scarf/Weil osteotomy will result in less residual second toe pain while achieving good functioning outcome. The aim of this study was to evaluate the presence of second toe pain after isolated scarf osteotomy versus combined Scarf/Weil osteotomy. Methods: Between January 2007 and June 2012, 439 patients underwent a scarf osteotomy for symptomatic hallux valgus at a tertiary hospital. Patients who underwent isolated scarf osteotomy were matched 1:1 to patients who had both Scarf and second toe Weil osteotomy. The following functional outcome scores were prospectively collected preoperatively and postoperatively at 6 and 24 months: American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal (MTP-IP) Scale, Visual Analog Scale (VAS), SF36-Physical Component Score (PCS) and Mental Component Score (MCS). Radiological outcomes such as the Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA) were measured. Statistical analysis was performed using SPSS® 20.0 and significance was defined as a p-value = 0.05. The Student’s unpaired t-test was used to compare the radiological and functional outcomes between the two groups of patients, while the paired t-test was used to analyze improvement in pre- and postoperative outcomes within each group. Results: 94.4% of the patients were female and no difference in BMI. In the Scarf/Weil group, the HVA and IMA improved by 21.2 ± 10.2 and 8.2 ± 4.7 degrees respectively (both P&lt;0.001). At 2 years, the AOFAS-hallux score improved by 26.6 ± 20.9 (p=0.034), AOFAS-second toe by 29.3 ± 20.9, VAS-hallux by 3.1 ± 3.4 (p&lt;0.001), VAS-second toe by 3.6 ± 3.2 (p&lt;0.001). In the Scarf group, the HVA and IMA improved by 17.1 ± 8.0 and 5.8 ± 4.3 degrees respectively (both p&lt;0.001). At 2 years, the AOFAS-hallux score improved by 32.2 ± 21.2 (p=0.034), AOFAS-second toe by 13.0 ± 16.3 (p &lt;0.001), VAS-hallux by 4.4 ± 3.3 (p&lt;0.001), VAS-second toe by 1.2 ± 2.4 (p&lt;0.001). Conclusion: A significant finding is that at 6 months and 2 years, the VAS-2nd toe score in the isolated Scarf group was 1 ± 0 point lower than the other group (p&lt;0.001). All other functional outcome scores were comparable between the two groups at 6 months. Our findings suggest that shortening second toe Weil osteotomy for large HV deformity may not fully resolve second toe metatarsalgia in the short-term, providing useful information for preoperative counselling.

Foot Width Changes Following Hallux Valgus Surgery

Category: Midfoot/Forefoot Introduction/Purpose: Hallux valgus is one of the most common deformities of the adult foot, and can adversely affect quality of life, with common complaints including pain, footwear restrictions and cosmesis. Every clinician is familiar with the patients’ concerns regarding the postoperative foot appearance and footwear anticipations. Surprisingly, although patients are concerned with postoperative foot width, there are only scarce reports on this issue. This study was undertaken to evaluate the impact of hallux valgus surgical treatment on foot width. Methods: Study included 71 consecutive cases with moderate to severe hallux valgus treated with Scarf osteotomy, distal soft tissue release and Akin osteotomy as needed. Patients were included only if pre- and postoperative weightbearing X-rays at minimum 6 months followup were available. The average age was 55.7 years (range, 20 to 76), with average follow-up of 20.7 months (range, 6 to 96). Patients’ medical records were reviewed for clinical data, surgical technique and radiographic measurements. The radiographic measurements included hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and foot width. Foot width was assessed by measuring both the bony width (BW: maximal distance between the medial cortex of 1st metatarsal head and lateral cortex of the 5th metatarsal head) and the soft tissue width (STW: maximal distance between most medial soft tissue outline and the most lateral soft tissue outline at the level of metatarsal heads). Results: Preoperative HV deformity (mean HVA 35.8, IMA 14.1 and DMAA 15.2) was successfully corrected (postoperative mean HVA 13.7, IMA 6.9 and DMAA 7.7). Overall bony foot width was reduced by 5% and soft tissue foot width by 2% postoperatively. Further analysis showed there were 13 feet (18.3%) with increased (&gt;5%) bone width, 26 feet (36.6%) with no change (±5%) and 32 feet (45.1%) for which width decreased in more than 5% postoperatively. Patients with the widest foot before surgery, had a decrease in foot width following surgery whereas, patients with the narrowest foot width, had an increase in foot width. Magnitude of preoperative deformity (as assessed by HVA, IMA and DMMA measurements) or amount of correction had low correlation (&lt;0.2) with postoperative foot width. Conclusion: While the ability of surgery to correct HV deformity is well established and reported in the literature, its effect on foot width is less understood or predictable. Overall, the postoperative reduction of foot with was modest. Furthermore, while postoperative foot width (both bony and soft tissue) decreases or does not change in 4 out of 5 patients, there are cases in which foot width actually increases.

Mucous Cyst at the Interphalangeal Joint of the First Toe Caused by Contact Pressure With the Second Toe due to Hallux Valgus

A 77-year-old woman presented with a mucous cyst on the lateral aspect of the interphalangeal joint of the first toe caused by contact pressure with the second toe from hallux valgus. She complained of discomfort and discharge from the left first toe for approximately 4 months. Physical examination showed the second toe pressing strongly against the first toe due to hallux valgus and discharge from the skin on the lateral aspect of the interphalangeal joint of the first toe. Magnetic resonance imaging showed a cystic lesion at the same level. The patient underwent a modified scarf osteotomy of the first metatarsal for hallux valgus to resolve the contact pressure between the toes— considered the cause of the mucous cyst—and resection of mucous cyst. Forefoot weight bearing was allowed 6 weeks after surgery. As of 1 year after surgery, she has had no recurrence of the cyst. The score on the Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal scale improved from 59/100 points to 92/100. This outcome suggests that hallux valgus correction should be considered when a mucous cyst is associated with contact pressure due to a hallux valgus deformity. To the best of our knowledge, there are no previous reports of a mucous cyst caused by contact pressure between the first toe and second toe due to hallux valgus.

Modified scarf osteotomy for hallux valgus

Category: Bunion Introduction/Purpose: To compare the elemental characteristics through a finite element (FE) model with an anatomically realistic geometry and structure of the metatarsophalangeal (MTP) joint. This model will estimate the biomechanical features and correction differences regarding dynamic loading and incidences of troughing. Methods: We retrospectively evaluated 40 patients who had undergone a modified rotational scarf osteotomy to correct for moderate to severe hallux valgus (HV) at our institution between January 2009 and December 2015. To compare the results and the elemental characteristics, we built a finite element model that included an anatomically realistic geometry and structure of the metatarsophalangeal (MTP) joint and estimated the biomechanical features and correction differences on dynamic loading as well as incidences of troughing. Results: Although the radiological outcomes remained unchanged within the first three months and moderately worsened over time as measured at the final radiographical assessment, all patients were satisfied with the results, including their visual analysis score (VAS) and American Orthopedic Foot &amp; Ankle Society (AOFAS) score. The rates of troughing and recurrence were remarkably lower in our pilot because of the innate stability of the modified rotated fixation. Conclusion: Our pilot findings suggest that the modified rotational scarf osteotomy procedure offers sufficient stability, optimal corrections and variable options.

Modified Scarf osteotomy for hallux valgus deformity in rheumatoid arthritis

Category: Midfoot/Forefoot Introduction/Purpose: For severe hallux valgus (HV) deformity in rheumatoid arthritis (RA) cases, arthrodesis of the 1st metatarsophalangeal (MTP) joint has been recommended. However, with the progress of medical treatment of RA, joint preservation surgery has recently been performed. This study aimed to investigate the clinical and radiographic outcomes of modified Scarf osteotomy with medial capsule interposition for RA cases, including severe 1st MTP joint destruction, and to evaluate risk factors for recurrence. Methods: A retrospective observational study of 76 cases (60 patients) [mean follow-up period: 35.3 months (24-56 months)] that underwent the modified Scarf osteotomy was performed. Japanese Society for Surgery of the Foot (JSSF) RA foot ankle scale scores, hallux scale scores, and a self-administered foot evaluation questionnaire (SAFE-Q) were evaluated, along with preoperative and postoperative radiographic parameters. Results: The mean JSSF RA foot and ankle and hallux score improved significantly (RA: preoperative: 52.2, final follow-up: 76.9, hallux: preoperative: 38.2, final follow-up: 74.5). Recurrence (hallux valgus angle (HVA) &gt;20°) occurred in 12 feet (15.8%). Preoperative DAS28-CRP (Disease activity score evaluated on 28 joints-C-reactive protein), intermetatarsal angle between the first and second metatarsal bone (M1M2A), and M1M5A, as well as HVA, M1M2A, M1M5A, and Hardy grade at 3 months after surgery, were significantly greater in the recurrence group. There was a significant negative correlation between preoperative DAS28-CRP and JSSF RA foot and ankle scores at final follow-up (ß = -0.39: p=0.02), while there was a significantly positive correlation between preoperative DAS28-CRP and HVA at the final follow-up (ß = 0.44: p=0.001). Conclusion: The modified Scarf osteotomy with medial capsule interposition for HV deformity improved clinical and radiographic outcomes in RA cases with severe 1st MTP joint destruction. Increased preoperative M1M2A and M1M5A, incomplete reduction of the sesamoid bone, HVA, M1M2A, and M1M5A at 3 months after surgery should be kept in mind for recurrence. The preoperative DAS28-CRP score was associated with clinical and radiographic outcomes after surgery.

Foot Width Changes Following Hallux Valgus Surgery.

Hallux valgus (HV) adversely affects quality of life. Patients frequently express concerns regarding postoperative foot appearance, foot width and footwear anticipations. However, only scarce data are available regarding postoperative foot width. Seventy-one cases with moderate to severe HV treated with scarf osteotomy were included. The average age was 55.7 years (range, 20-76), with average follow-up of 20.7 months (range, 6-96). Patients' medical records were reviewed for demographic, operative, and radiographic data. Foot width was assessed radiographically by measuring both bone (distance between the first and fifth metatarsal heads) and soft tissue width (maximal distance of the soft tissue outline). Preoperative HV deformity (mean hallux valgus angle [HVA] 35.8 degrees, intermetatarsal angle [IMA] 14.1 degrees, and distal metatarsal articular angle [DMAA] 15.2 degrees) was successfully corrected (postoperative mean HVA 13.7 degrees, IMA 6.9 degrees, and DMAA 7.7 degrees). Overall bony foot width was reduced by 5% and soft tissue foot width by 2%. Further analysis showed that 13 feet (18.3%) had increased (>5%) bone width, 26 feet (36.6%) with no change (±5%), and 32 feet (45.1%) for which the width decreased (>5%) postoperatively. Angular deformity (HVA, IMA, and DMAA) showed low correlation with postsurgery foot width. HV surgery effect on foot width was very limited, overall reducing foot width by 2%. Furthermore, in only about half of the patients, the postoperative foot width decreased, regardless of angular deformity magnitude. Patients with the widest feet had a decrease in foot width following surgery, whereas patients with the narrowest feet had an increase in foot width. Level III, comparative series.

Increased recurrence in Scarf osteotomy for mild & moderate hallux valgus with Meary’s line disruption

BackgroundScarf osteotomy for hallux valgus is a successful procedure. Neverthless recurrence of deformity is reported as 5–8%. First ray instability is a recognised risk factor for recurrence. We investigate whether a radiographic marker such as Meary’s line can be used to predict recurrence.This paper aims to test the null hypothesis that there is no difference in recurrence for mild and moderate hallux valgus treated with Scarf osteotomy in the presence of a disrupted Meary's line compared to an intact line. MethodsAt a minimum of 3 months follow up we retrospectively analysed radiographs, theatre and clinic notes of 74 (n=74) consecutive patients treated with Scarf osteotomy for mild and moderate hallux valgus at a single centre. The patients were divided into Group A (n=30) — patients who on pre-operative weight bearing radiographs had a disrupted Meary’s line, and Group B (n=44) — those with a normal Meary’s line on pre-operative weight bearing radiographs. ResultsOur results demonstrate statistically significant five times higher odds of recurrence in Group A compared to Group B with an odds ratio of 5.2 p=0.006 [95% CI 1.6–17]. On this basis we reject the Null hypothesis. ConclusionIn this paper, we link a disrupted Meary’s line with risk of recurrence of deformity. We demonstrate that, when Scarf osteotomy is used to correct mild and moderate hallux valgus in the presence of a broken Meary’s line, the odds of recurrence as compared to the same procedure being performed with an intact line are 5.2 times higher.Alternative corrective techniques such as the Lapidus procedure warrant further investigation for the treatment of mild and moderate hallux valgus in the presence of Meary’s line disruption.

Investigating How the Degree of Radiological Correction Corresponds to Patient Reported Outcomes in Scarf Osteotomy

Investigating How the Degree of Radiological Correction Corresponds to Patient Reported Outcomes in Scarf Osteotomy

Joint Preservation in the Rheumatoid Forefoot: Commentary on an article by Junichi Kushioka, MD, et al.: "Modified Scarf Osteotomy with Medial Capsule Interposition for Hallux Valgus in Rheumatoid Arthritis. A Study of Cases Including Severe First Metatarsophalangeal Joint Destruction".

Joint Preservation in the Rheumatoid Forefoot: Commentary on an article by Junichi Kushioka, MD, et al.: "Modified Scarf Osteotomy with Medial Capsule Interposition for Hallux Valgus in Rheumatoid Arthritis. A Study of Cases Including Severe First Metatarsophalangeal Joint Destruction".

Modified Scarf Osteotomy with Medial Capsule Interposition for Hallux Valgus in Rheumatoid Arthritis

Arthrodesis of the first metatarsophalangeal (MTP) joint has been recommended for severe hallux valgus deformity in patients with rheumatoid arthritis (RA). However, with the progress of medical treatment of RA, joint preservation surgery has recently been performed. The aim of this study was to investigate the clinical and radiographic outcomes of modified Scarf osteotomy with medial capsule interposition for RA cases including severe destruction of the first MTP joint and to evaluate risk factors for recurrence. A retrospective observational study of 76 cases (60 patients) followed for a mean of 35.3 months (range, 24 to 56 months) after a modified Scarf osteotomy was performed. Scores on the Japanese Society for Surgery of the Foot (JSSF) RA foot and ankle scale, the JSSF hallux scale, and a self-administered foot evaluation questionnaire (SAFE-Q) were determined along with preoperative and postoperative radiographic parameters. There was a significant improvement, from preoperatively to final follow-up, in the mean JSSF RA foot and ankle score (from 52.2 to 76.9 points) and the mean JSSF hallux score (from 38.2 to 74.5 points). There was a recurrence (hallux valgus angle [HVA] of >20°) in 12 feet (16%). The preoperative DAS28-CRP score (disease activity score [based on 28 joints in the body]-C-reactive protein score) and intermetatarsal angles between the first and second metatarsals (M1M2A) and between the first and fifth metatarsals (M1M5A) were significantly greater in the recurrence group, as were the HVA, M1M2A, M1M5A, and Hardy grade at 3 months after surgery. There was a significant negative correlation between the preoperative DAS28-CRP score and the JSSF RA foot and ankle score at final follow-up (β = -0.39, p = 0.02) and a significant positive correlation between the preoperative DAS28-CRP score and the HVA at final follow-up (β = 0.44, p = 0.001). The modified Scarf osteotomy with medial capsule interposition for hallux valgus deformity improved clinical and radiographic outcomes in RA cases with severe destruction of the first MTP joint. Increased preoperative M1M2A and M1M5A; incomplete reduction of the sesamoid bone; and the HVA, M1M2A, and M1M5A at 3 months after surgery should be evaluated as they are associated with recurrence of the deformity. The preoperative DAS28-CRP score was associated with the clinical and radiographic outcomes after surgery. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A randomized comparison of the proximal crescentic osteotomy and rotational scarf osteotomy in the treatment of hallux valgus

ObjectivesThe aim of this study was to compare clinical and radiological results of proximal crescentic osteotomy (PCO) and rotational scarf osteotomy performed in the treatment of hallux valgus. MethodsA total of 57 consecutive patients (60 feet) with symptomatic hallux valgus deformity were randomly assigned to one of two groups. The PCO group consisted of 22 women and 5 men (30 feet) and the mean age was 43(±14.5) years. The scarf group consisted of 23 women and 7 men (30 feet) and the mean age was 40.9(±12.6) years. Outcomes were assessed by using of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS). Weight bearing X-rays were used for radiological evaluation. ResultsThe mean AOFAS scores improved from 42(±16.2) to 66.7(±13.4) points in PCO group and from 36.2(±16.1) to 73.2(±13.5) points in scarf group. The mean pain score improved from 6.3(±1.3) to 2.4(±2) in PCO group and from 6.5(±1.9) to 2.5(±1.3) in scarf group. The mean hallux valgus angle (HVA) decreased from 38.1°(±7.1) preoperatively to 23.8°(±8.5) at postoperative first year in PCO group, and from 36.1°(±7.5) preoperatively to 22.2°(±7.5) at postoperative first year in scarf group. The mean intermetatarsal angle (IMA) decreased from 17.3°(±3.8) preoperatively to 11.8°(±3.3) at postoperative first year in PCO group, and from 16.2°(±2.6) preoperatively to 9.3°(±2.4) at postoperative first year in scarf group.When all the patients were assessed together, the relations between preoperative DMAA values and postoperative first year HVA (r = 0,327) and IMA (r = 0,399) values were positive but had low significance. The HVA and IMA values were increased in both groups at the end of the first year when compared to the postoperative sixth week values (p < 0.01 for both groups for both values). ConclusionThe PCO and the rotational scarf osteotomy in the treatment of hallux valgus deformity provides a satisfactory correction. The clinical and radiological results of both methods are similar. Especially in patients with high preoperative DMAA, an increase in the HVA and the IMA values may occur in the first postoperative year when compared to the postoperative sixth week values. Level of evidenceLevel II, therapeutic study.

Scarf versus long chevron osteotomies for the treatment of hallux valgus: A prospective randomized controlled study

BackgroundThe aim of this study is to compare scarf osteotomy and long chevron osteotomy in treatment of hallux valgus deformity regarding operative time, power of correction and complications. DesignA prospective randomized controlled comparative trial. Methods48 cases with hallux valgus were divided randomly in 2 groups (21 treated by scarf and 22 treated by long chevron osteotomy and 5 were missed during follow up), average age 36 years, follow up time was average of 25.9 months. Patients were assessed clinically, radiologically, and functional scoring system of American College of Foot and ankle Surgeons (ACFAS)was used both pre and postoperatively. ResultsOperative time was 69min in scarf group compared to 63min to long chevron group, radiological correction showed no statistically significant difference between both groups while functional improvement in ACFAS score was in favour of long chevron group 69.1% compared to scarf group 57.5% ConclusionsBoth osteotomies possess almost identical corrective power of the IMA (intermetatarsal angle) and similar clinical outcomes with slightly shorter operative time and subjective technical simplicity for the long chevron osteotomy.