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Butler JJ, Hartman H, Rettig S, Konar K, Randall G, Samsonov AP, Kennedy JG. Similar outcomes following scarf-Akin osteotomy compared to scarf-alone osteotomy for the treatment of hallux valgus: A systematic review and meta-analysis. Foot Ankle Surg 2024; 30:299-308. [PMID: 38218662 DOI: 10.1016/j.fas.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The purpose of this systematic review and meta-analysis was to compare the clinical and radiographic outcomes between patients undergoing scarf osteotomy and scarf-Akin osteotomy for the management of hallux valgus deformity. METHODS A systematic review of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical data following scarf osteotomy and scarf-Akin osteotomy for the treatment of hallux valgus were included and assessed. The level and quality of evidence of the included studies were also evaluated. RESULTS Four studies were included. In total, 388 patients (408 toes) underwent scarf osteotomy alone and 287 patients (295 toes) underwent scarf-Akin osteotomy for the treatment of hallux valgus deformity. There was no difference in postoperative American orthopedic foot and ankle society scores (p = 0.7828), visual analog scale scores (p = 0.4558), hallux valgus angle (p = 0.5116), intermetatarsal angle (p = 0.4830), proximal to distal phalangeal articular angle (p = 0.2411) between the scarf alone cohort and the scarf-Akin cohort. Similarly, there was no difference in complication rates (p = 0.6881) nor secondary surgical procedure rates (p = 0.3678) between the 2 cohorts. Finally, there was a higher recurrence rate in the scarf-alone cohort (11.4%) compared to the scarf-Akin cohort (5.7%), but this was not statistically significant (p = 0.4414). CONCLUSION This systematic review demonstrates lower recurrence rates following scarf-Akin osteotomy compared to scarf osteotomy alone for the treatment of hallux valgus deformity. No difference in complication rates were noted between the 2 cohorts. Our review demonstrates that both the scarf osteotomy and the scarf-Akin osteotomy may be effective and safe procedures, however, the scarf-Akin osteotomy may provide more long-term benefit in the setting of moderate to severe hallux valgus.
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Affiliation(s)
- James J Butler
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA
| | - Hayden Hartman
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA
| | - Samantha Rettig
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA
| | - Kishore Konar
- School of Medicine, University of Buckingham, United Kingdom
| | - Grace Randall
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA
| | - Alan P Samsonov
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA.
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Li Z, Yu W, Lin S, Fu K, Fang Z. Comparative effects of modified rotary scarf osteotomy and traditional scarf osteotomy in treating moderate to severe hallux valgus: a retrospective cohort study. BMC Musculoskelet Disord 2024; 25:61. [PMID: 38216881 PMCID: PMC10787438 DOI: 10.1186/s12891-023-07156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Traditional Scarf osteotomy (TSO) is an effective procedure with a good record in moderate to severe hallux valgus (MSHV) surgery. In order to overcome shortcomings of TSO, Modified Rotary Scarf osteotomy (MRSO) was introduced in this study, which aimed to compare the clinical and radiological outcome in the patients treated with MRSO or TSO. METHODS Of 175 patients (247 feet) with MSHV, 100 patients (138 feet) treated with MRSO and 75 patients (109 feet) treated with TSO were evaluated according to relevant indicators in twenty-four months follow-up. Pre-surgical and post-surgical HVA, IMA, DMAA, MTP-1 ROM, sesamoid grade and AOFAS (American Orthopaedic Foot and Ankle Society) scores and postsurgical complications were evaluated. RESULTS Both groups manifested similar baseline characters. The mean follow-up was of 25.9 (range, 22-37) months. Significantly lower IMA, lower Sesamoid grade and higher DMAA at six months, twelve months and twenty-four months post-surgically had been showed in MRSO group compared to TSO group. There was no significant difference in HVA, MTP-1 ROM and AOFAS data at each follow-up time point post-surgically between the two groups. No major complications occurred in either group. CONCLUSION MRSO showed comparable results to TSO, and improved IMA and sesamoid grade to a greater extent, with a lower probability of throughing effect. Although DMAA could be increased by MRSO, MRSO could still be a reproducible, non-dangerous and efficacious alternative procedure for treating HV patients which do not have severe DMAA.
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Affiliation(s)
- Zi Li
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Weiwei Yu
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Shiwei Lin
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Ke Fu
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Zhenhua Fang
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China.
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Watanabe K, Kubota M, Tanaka H, Nishiyama T, Hirao M, Fukushi JI, Kakihana M, Nozawa D, Okuda R. Japanese Orthopaedic Association (JOA) Clinical Practice Guidelines on the Management of Hallux Valgus - Secondary publication. J Orthop Sci 2024; 29:1-26. [PMID: 37451976 DOI: 10.1016/j.jos.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Kota Watanabe
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan.
| | - Makoto Kubota
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirofumi Tanaka
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Hyakutake Orthopedic Surgery and Sports Clinic, Saga, Japan
| | - Takayuki Nishiyama
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Makoto Hirao
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun-Ichi Fukushi
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masataka Kakihana
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Daisuke Nozawa
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryuzo Okuda
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
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Li Y, Wang Y, Wang F, Tang K, Tao X. Biomechanical Comparison between Rotational Scarf Osteotomy and Translational Scarf Osteotomy: A Finite Element Analysis. Orthop Surg 2023; 15:3243-3253. [PMID: 37731316 PMCID: PMC10694014 DOI: 10.1111/os.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/13/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE Rotational Scarf osteotomy has its unique advantages in treating hallux valgus, but it also has certain drawbacks. The biomechanical differences between rotational Scarf and translational Scarf osteotomy are not clear evaluates the correction ability and biomechanical difference of two surgical methods for hallux valgus by finite element analysis. METHODS The computerized tomography data of a hallux valgus patient were selected to establish a finite element model. The standard Scarf osteotomy was simulated based on the model, and the rotation and translation were performed, respectively. The size of the intermetatarsal angle, contact area, distal metatarsal articular angle and the absolute length of the first metatarsal was compared between the two groups. We completed the cartilage, ligament and other tissues on the bone model to establish a full foot model. We analyzed the troughing, plantar aponeurosis tension, plantar soft tissue, and ground stress and also observed the stability of the fracture site by a three-point bending test. RESULTS Both surgical methods may effectively correct the intermetatarsal angle. After rotational osteotomy, the contact area increased, and the length of the first metatarsal bone initially increased and then decreased compared to that in the translational group. Furthermore, rotational Scarf significantly increased the distal metatarsal articular angle. Mechanical analysis showed that the cancellous bone in the contact part of the fracture site in the translation group had greater stress, which was the reason for the occurrence of the troughing. Stress distribution of plantar aponeurosis, plantar soft tissue, and the ground showed no significant difference. The three-point bending test showed that the separation of the broken ends of the rotational Scarf osteotomy model (0.133 mm) was slightly smaller than the translational group (0.147 mm). CONCLUSION Both surgical methods can successfully correct intermetatarsal angle (IMA). Compared to traditional translational Scarf osteotomy, rotational Scarf osteotomy is more conducive to postoperative stability and healing, but it also has certain drawbacks. In clinical practice, individualized surgical methods still need to be selected for different types of patients with hallux valgus.
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Affiliation(s)
- Yan Li
- Department of Orthopaedics/Sports Medicine CenterThe First Affiliated Hospital of Army Medical UniversityChongqingChina
| | - Yue Wang
- College of Physical Education and HealthChongqing Normal UniversityChongqingChina
| | - Feng Wang
- Department of Orthopaedics/Sports Medicine CenterThe First Affiliated Hospital of Army Medical UniversityChongqingChina
| | - Kanglai Tang
- Department of Orthopaedics/Sports Medicine CenterThe First Affiliated Hospital of Army Medical UniversityChongqingChina
| | - Xu Tao
- Department of Orthopaedics/Sports Medicine CenterThe First Affiliated Hospital of Army Medical UniversityChongqingChina
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Najefi AA, Alsafi MK, Katmeh R, Zaveri AK, Cullen N, Patel S, Malhotra K, Welck M. First Metatarsal Rotation After Scarf Osteotomy for Hallux Valgus. Foot Ankle Spec 2023:19386400231172248. [PMID: 37243475 DOI: 10.1177/19386400231172248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Recurrence after surgical correction of hallux valgus may be related to coronal rotation of the first metatarsal. The scarf osteotomy is a commonly used procedure for correcting hallux valgus but has limited ability to correct rotation. Using weight-bearing computed tomography (WBCT), we aimed to measure the coronal rotation of the first metatarsal before and after a scarf osteotomy, and correlate these to clinical outcome scores. METHODS We retrospectively analyzed 16 feet (15 patients) who had a WBCT before and after scarf osteotomy for hallux valgus correction. On both scans, hallux valgus angle (HVA), intermetatarsal angle (IMA), and anteroposterior/lateral talus-first metatarsal angle were measured using digitally reconstructed radiographs. Metatarsal pronation angle (MPA), alpha angle, sesamoid rotation angle, and sesamoid position were measured on standardized coronal WBCT slices. Preoperative and postoperative (12 mo) clinical outcome scores (Manchester Oxford Foot Questionnaire and Visual Analogue Scores) were captured. RESULTS Mean HVA was 28.6 ± 10.1° preoperatively and 12.1 ± 7.7° postoperatively (P < .001). Mean IMA was 13.7 ± 3.8° preoperatively and 7.5 ± 3.0° postoperatively (P < .001). Before and after surgery, there were no significant differences in MPA (11.4 ± 7.7 and 11.4 ± 9.9°, respectively; P = .75) or alpha angle (10.9 ± 8.0 and 10.7 ± 13.1°, respectively; P = .83). There were significant improvements in sesamoid rotation angle (SRA) (26.4 ± 10.2 and 15.7 ± 10.2°, respectively; P = .03) and sesamoid position (1.4 ± 1.0 and 0.6 ± 0.6, respectively; P = .04) after a scarf osteotomy. There were significant improvements in all outcome scores after surgery. Poorer outcome scores correlated with greater postoperative MPA and alpha angles (r = .76 (P = .02) and .67 (P = .03), respectively). CONCLUSION A scarf osteotomy does not correct first metatarsal coronal rotation, and worse outcomes are linked to greater postoperative metatarsal rotation. Rotation of the metatarsal needs to be measured and considered when planning hallux valgus surgery. Further work was needed to compare postoperative outcomes with rotational osteotomies and modified Lapidus procedures when addressing rotation.Level of Evidence: 4.
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Affiliation(s)
- Ali-Asgar Najefi
- Foot & Ankle Unit, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
| | | | - Rateb Katmeh
- Foot & Ankle Unit, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
| | - Amit Kamal Zaveri
- Foot & Ankle Unit, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
| | - Nicholas Cullen
- Foot & Ankle Unit, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
| | - Shelain Patel
- Foot & Ankle Unit, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
| | - Karan Malhotra
- Foot & Ankle Unit, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
| | - Matthew Welck
- Foot & Ankle Unit, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
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Li Y, Wang Y, Tang K, Tao X. Modified scarf osteotomy for hallux valgus: From a finite element model to clinical results. J Orthop Surg (Hong Kong) 2022; 30:10225536221143816. [PMID: 36459594 DOI: 10.1177/10225536221143816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE 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). METHOD 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. RESULTS Both the hallux valgus angle (HVA) and intermetatarsal angle (IMA) showed significant improvement 6 weeks postoperatively (p < 0.05); additionally, the HVA increased from 6 weeks 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. CONCLUSION 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.
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Affiliation(s)
- Yan Li
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
| | - Yue Wang
- College of Physical Education and Health, 12524Chongqing Normal University, Chongqing, China
| | - Kanglai Tang
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
| | - Xu Tao
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
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The Incidence of Complications Following Scarf Osteotomy for the Treatment of Hallux Valgus: A Systematic Review with Meta-Analysis. J Foot Ankle Surg 2022:S1067-2516(22)00340-4. [PMID: 37097272 DOI: 10.1053/j.jfas.2022.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
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.
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Kaufmann G, Braito M, Wagner M, Putzer D, Ulmer H, Dammerer D. Correlation of Loss of Correction With Postoperative Radiological Factors After Distal Chevron Osteotomy in Dependence of Concomitant Akin Osteotomy. J Foot Ankle Surg 2022; 61:785-791. [PMID: 34973863 DOI: 10.1053/j.jfas.2021.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 09/12/2020] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
Loss of correction is frequently observed following hallux valgus correction and is associated with recurrence of a hallux valgus deformity. The purpose of this study was to correlate loss of correction and radiological parameters following distal chevron (Group C) and combined chevron/akin (Group AC) osteotomy. A total of 859 feet were included for analysis and grouped according to treatment with a distal chevron osteotomy alone or a combined chevron/akin osteotomy. Radiographs were evaluated preoperatively, postoperatively, after 6 weeks, 3 months and, if available, at long term follow-up with a mean of 34.2 (range 7.5-155.3) months. With the exception of the proximal to distal phalangeal articular angle (PDPAA), preoperative deformity was comparable between both groups. Significant correction of all examined parameters (p < .001) was seen. Loss of correction at 6 weeks with minor deterioration until follow-up was also detected, with group AC somewhat better than Group C. A strong correlation with loss of correction was found for the postoperative hallux valgus angle (HVA) (p < .002), intermetatarsal angle (IMA) (p < .001), distal metatarsal articular angle (DMAA) (p < .002), positioning of the sesamoids (p < .002) and joint congruity (p < .035) in Group C and for the DMAA (p < .033) and HVA (p < .046) in Group AC. Multiple postoperative radiological parameters correlated with loss of correction following distal chevron osteotomy. In Group AC only postoperative HVA and DMAA determined loss of correction. Correction of the deformity in Group AC showed greater stability.
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Affiliation(s)
| | - Matthias Braito
- Department of Orthopedic Surgery, District Hospital St. Johann, St. Johann, Austria
| | - Moritz Wagner
- Department of Orthopedic Surgery, District Hospital St. Johann, St. Johann, Austria
| | - David Putzer
- Department of Experimental Orthopedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Senior Author, Department of Orthopedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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9
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Suh JW, Jang HS, Park HW. Iatrogenic second transfer metatarsalgia and the first metatarsal shortening and elevation after Scarf osteotomy. Foot Ankle Surg 2022; 28:464-470. [PMID: 34838426 DOI: 10.1016/j.fas.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/13/2021] [Accepted: 11/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Transfer metatarsalgia is a potential complication of hallux valgus surgery. This study aimed to investigate the shortened first metatarsal length and elevation and to compare groups with and without second transfer metatarsalgia after Scarf osteotomy. METHODS The first metatarsal length of 123 feet was measured via the Maestro's method using the metatarsal axial length and the relative second metatarsal protrusion to the first metatarsal. Metatarsal elevation was measured using the first metatarsal angle. RESULTS Second transfer metatarsalgia occurred after Scarf osteotomy in 11 (8.9%) feet. When baseline characteristics were considered in propensity score matching, the 11 feet were compared with the 33 feet in the control group. The group with transfer metatarsalgia showed a more shortened first metatarsal axial length (-4.1 ± 1.8 mm vs. -2.5 ± 2.2 mm, p = 0.032), a significantly longer relative second metatarsal protrusion (+5.8 ± 2.6 mm vs. +1.2 ± 2.6 mm, p < 0.001), and a significantly lower first metatarsal angle (18.1 ± 4.3° vs. 21.5 ± 4.0°, p = 0.012) than the control group postoperatively. CONCLUSIONS To avoid iatrogenic transfer metatarsalgia, first metatarsal length shortening should be minimized to at least less than 4.0 mm. Furthermore, the metatarsal parabola should be retained.
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Affiliation(s)
- Jae Wan Suh
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Ho-Seong Jang
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Hyun-Woo Park
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea.
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10
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Feeney KM, Kearns SR. A Technique to Correct Troughing in a Z-Osteotomy for Hallux Valgus Correction. J Foot Ankle Surg 2021; 60:814-816. [PMID: 33771434 DOI: 10.1053/j.jfas.2020.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 02/03/2023]
Abstract
A Z-osteotomy is a commonly performed procedure to correct mild-moderate hallux valgus. It is an effective procedure with high patient satisfaction rates. However, it is not without its challenges. One of the most frequently encountered issues during a Z-osteotomy is troughing of the first metatarsal. We present a simple surgical technique to correct troughing if it is encountered without the need for additional soft tissue or bony procedures.
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Affiliation(s)
- Kaylem M Feeney
- Clinical Specialist Podiatrist, Bons Secours Hospital, Galway, Ireland.
| | - Stephen R Kearns
- Consultant Orthopaedic Surgeon, Galway University Hospitals, Ireland
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11
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Peng J, Wang Q, Jha AJ, Pitts C, Li Q, Brahmbhatt A, Shah AB. The Rotational Effect of Scarf Osteotomy With Transarticular Lateral Release on Hallux Valgus Correction. J Foot Ankle Surg 2021; 60:328-332. [PMID: 33423891 DOI: 10.1053/j.jfas.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/07/2020] [Accepted: 11/09/2020] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to explore the rotational effect of scarf osteotomy with transarticular lateral release (TALR) on hallux valgus correction. From January 2016 to January 2018, 28 consecutive patients (30 feet) were included in this study. The first intermetatarsal angle (IMA), hallux valgus angle (HVA), and round-shaped lateral edge of the first metatarsal head (R sign), and sesamoid rotation angle (SRA) were recorded prior to and 3 months after the surgery. The rotation of the capital fragment of the first metatarsal was termed the capital rotation angle (CRA) and was measured intraoperatively after the completion of scarf osteotomy. The IMA, HVA, and SRA were significantly reduced from 13.9 ± 4.9°, 34.6 ± 7.4°, and 28.7 ± 9.8° to 2.4 ± 2.3°, 7.3 ± 4.7°, and 13.4 ± 8.8°, respectively (p < .01 for all). The mean CRA was 7.0 ± 3.4° and was not significantly correlated with the reduction of IMA and SRA (p > .05 for all); nor was it significantly correlated with IMA preoperatively and postoperatively (p > .05 for all) or the reduction of SRA and IMA (p > .05). The R sign was positive in 40% (12/30) of the feet preoperatively compared to 13.3% (4/30) postoperatively (p < .001). Scarf osteotomy produced a supination effect on the capital fragment of the first metatarsal and supinated the sesamoids via lateral translation of the first metatarsal head. These changes may contribute to the correction of the pronation component of hallux valgus deformity.
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Affiliation(s)
- Jianguang Peng
- Associate Professor, Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiang Wang
- Associate Professor, Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Aaradhana J Jha
- Trauma Fellow, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Charles Pitts
- Resident Physician, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Qi Li
- Associate Professor, Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ashish Brahmbhatt
- Foot and Ankle Fellow, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Ashish B Shah
- Associate Profressor, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
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12
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Kaufmann G, Giesinger JM, Hofer P, Braito M, Biedermann R, Dammerer D. Does preoperative deformity diminish radiographic outcome after hallux valgus correction with scarf osteotomy?: A retrospective study of 102 cases. Foot Ankle Surg 2020; 26:425-431. [PMID: 31202526 DOI: 10.1016/j.fas.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 02/25/2019] [Accepted: 05/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scarf osteotomy is a frequently used technique to correct moderate to severe hallux valgus deformities. Recurrence of a deformity is a commonly reported complication after surgery. The aim of our study was to evaluate the impact of preoperative deformity on radiological outcome in terms of postoperative loss of correction after scarf osteotomy. METHODS 102 patients, in which a hallux valgus deformity was corrected with an isolated scarf osteotomy were included. Weightbearing radiographs were analyzed preoperatively, postoperatively, after 6 weeks and after three months (mean 10.9 months SD 17.2 months). The following radiological parameters were used for analysis: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), position of the sesamoids, first metatarsal length, and first metatarsophalangeal joint congruity. RESULTS Significant correction of IMA, HVA, DMAA, sesamoid position and joint congruity was achieved (p < 0.001). The IMA improved from 15.8 ± 2.3 to 4.3 ± 2.8°, the HVA from 32.6 ± 6.8 to 9.1 ± 7.2, and the DMAA from 11.4 ± 6.9 to 8.4 ± 5.2°, respectively. In contrast to DMAA, throughout followup we could detect loss of correction for HVA and for IMA amounting 6.3° ± 5.8 and 3.8° ± 2.8 respectively. Loss of HVA correction revealed a significant correlation with preoperative DMAA, but not with the other preoperative radiological parameters. CONCLUSIONS Preoperative deformity does not correlate with postoperative loss of correction after scarf osteotomy, except DMAA. CLINICAL RELEVANCE Our results may be helpful in counseling patients regarding recurrence of hallux valgus deformity after scarf osteotomy. LEVEL OF EVIDENCE Therapeutic, Level IV, retrospective case series.
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Affiliation(s)
- Gerhard Kaufmann
- OFZ Innsbruck, Orthopedic and Foot Centre Innsbruck, Innrain 2/3. Stock, 6020, Innsbruck, Austria.
| | - Johannes M Giesinger
- Institute of Patient-centered Outcome Research (IIPCOR), Dr. Stumpf Straße 56, 6020, Innsbruck, Austria.
| | - Philipp Hofer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Matthias Braito
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Rainer Biedermann
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Dietmar Dammerer
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Sanhudo JAV, Pereira TAP. Current Trends in Fixation Techniques. Foot Ankle Clin 2020; 25:97-108. [PMID: 31997750 DOI: 10.1016/j.fcl.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hallux valgus is an extremely common and often disabling deformity. In addition to valgus deformity of the hallux, varying degrees of varus and supination of the first metatarsal and instability in the metatarsophalangeal and metatarsocuneiform joints are frequently present. Because of the complexity and multiplicity of deformities, surgical techniques and fixation methods continue to be developed to obtain better results. Recent studies have focused on correcting pronation of the first metatarsal as a way of correcting and equalizing the metatarsal sesamoid bones in a more horizontal and stable position, possibly minimizing the chance of recurrence of the deformity.
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Siddiqui NA, LaPorta G, Walsh AL, Abraham JS, Beauregard S, Gdalevitch M. Radiographic Outcomes of a Percutaneous, Reproducible Distal Metatarsal Osteotomy for Mild and Moderate Bunions: A Multicenter Study. J Foot Ankle Surg 2019; 58:1215-1222. [PMID: 31679675 DOI: 10.1053/j.jfas.2019.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 02/14/2019] [Accepted: 04/26/2019] [Indexed: 02/03/2023]
Abstract
Hallux valgus is a prevalent condition. Many open surgical methods of correction have been described. We performed a percutaneous, extra-articular distal metatarsal osteotomy for mild to moderate bunion deformity. The minimally invasive technique was used in 217 feet (180 patients; age 49 ± 4.7 years, mean ± standard deviation) at 4 centers in North America (Center 1: November 2012 to March 2017; Center 2: January 2010 to May 2016; Center 3: October 2013 to June 2016; Center 4: January 2015 to June 2017). The procedure was used in simultaneous bilateral cases in 28 patients (15.6%) and in nonsimultaneous bilateral cases in 9 patients (5.0%). Immediate postoperative weightbearing was used in all cases. The mean preoperative intermetatarsal angle, hallux abductus angle, and tibial sesamoid position were 14.6° ± 3.5°, 30.7° ± 7.8°, and 5.4 ± 1.4, respectively. At final follow-up of 9.3 ± 6.1 months, the mean intermetatarsal angle, hallux abductus angle, and tibial sesamoid position were 4.7° ± 2.8°, 8.4° ± 6.1°, and 2.0 ± 1.0, respectively (p < .0001 for all comparisons). No major complications were noted. All 217 osteotomies achieved union; 3 feet (1.4%) in 3 patients (1.7%) experienced asymptomatic malunion. Superficial pin-site infection was seen in 42 (19.4%) of the 217 feet (39 patients, 21.7%). The radiographic results of this percutaneous technique appear to be reproducible across multiple centers, and the technique is useful when correcting intermetatarsal and hallux abductus angles. This percutaneous osteotomy for realignment of the first ray allows immediate postoperative weightbearing and, in this initial review, appears to be safe and effective, even in simultaneous bilateral cases.
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Affiliation(s)
- Noman A Siddiqui
- Director, Podiatric Surgery, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; Fellowship Director, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
| | - Guido LaPorta
- Surgeon, Geisinger Community Medical Center, Scranton, PA; Director, Podiatric Medical Education, Lourdes Hospital, Binghamton, NY
| | - Amanda L Walsh
- Surgeon, The Foot and Ankle Clinic of Central Nebraska, Grand Island, NE
| | | | - Serge Beauregard
- First Assistant Nurse, Orthopedic Surgery Department, Verdun Hospital, Montreal, Quebec, Canada
| | - Marie Gdalevitch
- Surgeon, Orthopedic Surgery Department, Verdun Hospital, Montreal, Quebec, Canada
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Xiong Y, Shen B, Hao C, Xiao K, Wang J, Fang Z. Transfer of abductor hallucis tendon combined with scarf osteotomy versus single scarf osteotomy in moderate to severe hallux valgus deformity: a comparative retrospective cohort study. BMC Musculoskelet Disord 2019; 20:455. [PMID: 31630676 PMCID: PMC6802301 DOI: 10.1186/s12891-019-2860-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/01/2019] [Indexed: 11/21/2022] Open
Abstract
Background Scarf osteotomy (SO) was broadly applied in moderate to severe hallux valgus (MSHV), and the results were satisfactory. However, due to the complicated pathologic changes in hallux valgus, the ideal surgical treatment is still controversial. Transfer of the abductor hallucis tendon combined with Scarf osteotomy (TAHTCSO) was an innovative alternative technique. This retrospective cohort study aimed to define if TAHTCSO mode resulted in improved outcomes as compared with the single SO in MSHV. Methods Of 73 patients (92 ft) with MSHV, 36 (45 ft) were treated through TAHTCSO and 37 ones (47 ft) through SO. The patients were assessed clinically and radiographically with a 24-month follow-up. They were assessed pre-operatively and post-operatively with intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), first metatarsophalangeal joint range of motion (1#MTP ROM), as well as American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores and postoperative complications of surgery. Results Both cohorts had the same baseline feathures. All patients were followed up from 24 to 40 months, with a mean of 28.3 months. Patients in the TAHTCSO cohort had significantly decreased HVA at 6 months (p < 0.0001), 12 months (p < 0.0001), and 24 months (p < 0.0001) after surgery. 1#MTP had been increased slightly with non-statistic sense (p>0.05). IMA, DMAA and AOFAS also had not significantly difference at all followed time after surgery as compared with the SO cohort. The healing of osteotomies was observed within 8 weeks in the two cohorts. Two cases of hallus varus had been found in SO cohort and there were no cases of delayed healing and bone non-union in both cohorts. Conclusion In this retrospective cohort study, TAHTCSO had sufficient maintenance of the correction and improved functional performance thereby was a good alternative for MSHV, though it did not display a better result for MSHV compared to SO.
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Affiliation(s)
- Yuan Xiong
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Bo Shen
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Cheng Hao
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Kai Xiao
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Junwen Wang
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Zhenhua Fang
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China.
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Kaufmann G, Hofer P, Braito M, Bale R, Putzer D, Dammerer D. Effect of Akin Osteotomy on Hallux Valgus Correction After Scarf Osteotomy With Hallux Valgus Interphalangeus. Foot Ankle Int 2019; 40:1182-1188. [PMID: 31200616 DOI: 10.1177/1071100719855043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrence after hallux valgus correction is a relatively frequent occurrence. Little is known about the importance of initial correction on radiologic outcome. The objective of our study was to determine postoperative radiologic parameters correlating with loss of correction after scarf osteotomy and the combined scarf/akin osteotomy, respectively. METHODS Loss of correction was evaluated based on a group of 53 feet with isolated scarf osteotomy (S group) and a group of 17 feet with combined scarf and akin osteotomy (SA group) in a retrospective analysis. The intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), the position of the sesamoids, and joint congruity were measured in weight-bearing radiographs preoperatively and postoperatively throughout a mean follow-up of 44.8 ± 23.6 months. RESULTS Loss of correction was comparable between the S and the SA group (P > .05). In contrast, we found higher loss of HVA correction in the S subgroup with a preoperative PDPAA above 8 degrees (P = .011), whereas loss of correction in the S subgroup below 8 degrees of PDPAA was comparable to the SA group. In the S group, loss of correction showed significant correlation with postoperative IMA (P = .015) and PDPAA (P = .008), whereas in the SA group a correlation could be detected for IMA only (P = .045). CONCLUSION In cases with a PDPAA above 8 degrees, we recommend a combined scarf/akin osteotomy to diminish the potential for loss of correction. LEVEL OF EVIDENCE Level III, therapeutic, retrospective comparative series.
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Affiliation(s)
| | - Philipp Hofer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Braito
- Orthopedic Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Orthopedic Department, Medical University of Innsbruck, Innsbruck, Austria
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17
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Kaufmann G, Hofmann M, Ulmer H, Putzer D, Hofer P, Dammerer D. Outcomes after scarf osteotomy with and without Akin osteotomy a retrospective comparative study. J Orthop Surg Res 2019; 14:193. [PMID: 31242910 PMCID: PMC6595682 DOI: 10.1186/s13018-019-1241-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/16/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The scarf osteotomy is a well-established surgical method for correcting a hallux valgus deformity. It is often combined with an Akin osteotomy. However, clear guidelines defining indication criteria are missing. The purpose of this study was to analyze the radiological outcome after scarf osteotomy in dependence of additional Akin osteotomy. METHODS This study included 184 patients in whom a hallux valgus deformity was corrected with a scarf osteotomy (group S), and 63 patients in whom an additional Akin osteotomy was performed (group SA). Weight-bearing radiographs were evaluated preoperatively, postoperatively, after 6 weeks, after 3 months and at a follow-up with a mean of 45.4 months. Analysis was made for the following radiological parameters: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), and the position of the sesamoids as well as the joint congruity. RESULTS Radiographic recurrence (HVA > 20°) was detected in 1 patient (1.6% of recurrence) in the SA group, and in 27 patients in the S group (14.7% of recurrence) at follow-up. Outcome between the two groups differed significantly showing reduced loss of HVA correction in the SA group (p < 0.001). The subgroup with a preoperative PDPAA above eight degrees showed significant inferiority of outcome for the S group compared to the SA group. CONCLUSION Radiological outcome after scarf osteotomy is superior with concomitant Akin osteotomy. A preoperative PDPAA above eight degrees makes additional Akin osteotomy recommendable. LEVEL OF EVIDENCE Therapeutic, Level III, retrospective comparative series.
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Affiliation(s)
| | - Maximilian Hofmann
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopedics, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Philipp Hofer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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18
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Boychenko AV, Solomin LN, Belokrylova MS, Tyulkin EO, Davidov DV, Krutko DM. Hallux Valgus Correction With Rotational Scarf Combined With Adductor Hallucis Tendon Transposition. J Foot Ankle Surg 2019; 58:34-37. [PMID: 30448186 DOI: 10.1053/j.jfas.2018.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Indexed: 02/03/2023]
Abstract
Hallux valgus affects 23% of people older than 40 years, and there are hundreds of methods dealing with this pathology, which have their advantages and disadvantages. The aim of the present prospective cohort study was to report our experience in treating the patients with hallux valgus and to perform a comparative analysis of the outcomes of the innovative and standard methods of surgical correction. Data on 78 patients (113 feet) with hallux valgus operated on between March 2010 and December 2015 using either an innovative method, which included rotational scarf osteotomy with bone fragment impaction and adductor hallucis tendon reinsertion, or the classical scarf osteotomy were analyzed. X-ray examination was performed preoperatively and 3 and 36 months after the procedure. A comparative analysis of the outcomes between the groups was carried out. No significant difference in mean radiographic data (p > .05) was found between these 2 groups preoperatively and 3 months after surgery. Nevertheless, the mean intermetatarsal angle 36 months after surgery in standard and innovative groups was 9.7 ± 0.7° and 9.0 ± 0.8° (p < .01) and the mean metatarsophalangeal angle 13.6 ± 0.9° and 13.2 ± 1.1° (p = .01), respectively. The innovative method of surgical correction of hallux valgus was seen to produce improved radiographic results.
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Affiliation(s)
- Anton V Boychenko
- Surgeon, Faculty of Medicine, Department of General Surgery, St. Petersburg State University, St. Petersburg, Russian Federation; Surgeon, City Hospital No. 2, St. Petersburg, Russian Federation.
| | - Leonid N Solomin
- Professor, Faculty of Medicine, Department of General Surgery, St. Petersburg State University, St. Petersburg, Russian Federation; Professor, Russian Research Institution of Traumatology and Orthopedics named after R.R. Vreden, Federal State Healthcare Organization, Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation
| | - Maria S Belokrylova
- Associate Registrar, Faculty of Medicine, Department of General Surgery, St. Petersburg State University, St. Petersburg, Russian Federation; Associate Registrar, Russian Research Institution of Traumatology and Orthopedics named after R.R. Vreden, Federal State Healthcare Organization, Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation
| | - Evgeny O Tyulkin
- Associate Registrar, Faculty of Medicine, Department of General Surgery, St. Petersburg State University, St. Petersburg, Russian Federation; Associate Registrar, City Hospital No. 2, St. Petersburg, Russian Federation
| | - Denis V Davidov
- Professor, The Main Military Clinical Hospital named after N.N. Burdenko, Moscow, Russian Federation
| | - Denis M Krutko
- Associate Registrar, Faculty of Medicine, Department of Introductory Course of Internal Diseases, St. Petersburg State University, St. Petersburg, Russian Federation
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19
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Young KW, Lee HS, Park SC. Modified Proximal Scarf Osteotomy for Hallux Valgus. Clin Orthop Surg 2018; 10:479-483. [PMID: 30505417 PMCID: PMC6250972 DOI: 10.4055/cios.2018.10.4.479] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/01/2018] [Indexed: 12/19/2022] Open
Abstract
Background We developed a modified proximal scarf osteotomy technique for moderate to severe hallux valgus in an attempt to obtain better correction of the deformity. In addition, we compared the clinical and radiographic results of this modified technique with those of the classic scarf osteotomy reported in other studies. Methods Between December 2004 and July 2009, 44 cases of modified proximal scarf osteotomy was performed in 35 patients with moderate hallux valgus. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of motion of the first metatarsophalangeal joint, and radiographic results were evaluated. Results The mean hallux valgus angle and the mean first intermetatarsal angle improved from an average of 32.2° and 14.3°, respectively, to an average of 12.5° and 8.6°, respectively. The distal metatarsal articular angle improved from an average of 18.7° to 12.4°. The preoperative mean AOFAS and VAS scores were 47 points and 7 points, respectively, which improved to 86 points and 1 point, respectively, at the final follow-up. Limited range of motion occurred in two cases postoperatively. The height of the first metatarsal-cuneiform joint, which was an average of 15.9 mm preoperatively, did not change. The first metatarsal-talus angle increased from an average of 4.1° to 7.1°. Conclusions The modified proximal scarf osteotomy for the treatment of moderate hallux valgus showed similar results with the classic scarf osteotomy with regard to changes in the first intermetatarsal angle and postoperative satisfaction. Therefore, we suggest the modified proximal scarf osteotomy be considered as well as other proximal osteotomy in the treatment of moderate to severe hallux valgus.
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Affiliation(s)
- Ki Won Young
- Department of Foot and Ankle Surgery, Eulji Medical Center, Eulji University, Seoul, Korea
| | - Hong Seop Lee
- Department of Foot and Ankle Surgery, Eulji Medical Center, Eulji University, Seoul, Korea
| | - Seong Cheol Park
- Department of Foot and Ankle Surgery, Eulji Medical Center, Eulji University, Seoul, Korea
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20
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Şahin N, Cansabuncu G, Çevik N, Türker O, Özkaya G, Özkan Y. A randomized comparison of the proximal crescentic osteotomy and rotational scarf osteotomy in the treatment of hallux valgus. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:261-266. [PMID: 29606549 PMCID: PMC6150448 DOI: 10.1016/j.aott.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/19/2017] [Accepted: 02/26/2018] [Indexed: 11/12/2022]
Abstract
Objectives The 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. Methods A 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. Results The 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). Conclusion The 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 evidence Level II, therapeutic study.
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21
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Abstract
Hallux valgus is a slowly progressing complex 3-dimensional biomechanical process. Therefore, precise understanding of 3-dimensional deformity is essential for satisfactory clinical result. Uniplanar correction on anteroposterior view of foot would be insufficient, and rotation on frontal plane as well as sagittal alignment should also be well corrected. This article will review the 3-dimensional components of bony displacement in different surgical methods for hallux valgus correction.
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Affiliation(s)
- Young Yi
- Department of Orthopedic Surgery, Seoul Paik Hospital Inje University, Joel-Dong 2 Ga 85, Jung-GU, Seoul 100-032, Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopedic Clinic, Dongjak-Daero 212, Seocho-Gu, Seoul 06554, Korea.
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22
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Swanton E, Mason L, Molloy A. How Do I Use the Scarf Osteotomy to Rotate the Metatarsal and Correct the Deformity in Three Dimensions? Foot Ankle Clin 2018; 23:239-246. [PMID: 29729798 DOI: 10.1016/j.fcl.2018.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The scarf osteotomy has become the workhorse procedure for a large proportion of foot and ankle surgeons, especially in Europe, in the treatment of hallux valgus. Such a versatile procedure should not be underestimated, and planning and thought should precede any such procedure. The angle of bone cuts and magnitude of translation dictate the final position, and all movement axes should be given equal attention.
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Affiliation(s)
- Eric Swanton
- Consultant Orthopaedic Surgeon, Aintree University Hospital, Lower Lane, Liverpool L9 7AL, Merseyside, UK
| | - Lyndon Mason
- Consultant Orthopaedic Surgeon, Aintree University Hospital, Lower Lane, Liverpool L9 7AL, Merseyside, UK; Honorary Clinical Senior Lecturer, Department of Musculoskeletal Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Andy Molloy
- Consultant Orthopaedic Surgeon, Aintree University Hospital, Lower Lane, Liverpool L9 7AL, Merseyside, UK; Honorary Clinical Senior Lecturer, Department of Musculoskeletal Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK.
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23
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Abstract
Hallux valgus is a common pathology of the foot and ankle. Surgical correction of the condition has been described as early as 1836. Since then, numerous different surgical techniques have been documented in the literature. One of the explanations as to why there are so many different surgeries for hallux valgus is the variety of etiologies attributed to causing the condition. This article discusses the etiologies associated with hallux valgus and describes a few of the surgeries commonly used to treat the deformity.
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Affiliation(s)
- Niall A Smyth
- Department of Orthopaedic Surgery, University of Miami, 1611 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Amiethab A Aiyer
- Department of Orthopaedic Surgery, University of Miami, 1611 Northwest 12th Avenue, Miami, FL 33136, USA.
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24
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Lee SC, Hwang SH, Nam CH, Baek JH, Yoo SY, Ahn HS. Technique for Preventing Troughing in Scarf Osteotomy. J Foot Ankle Surg 2018; 56:822-823. [PMID: 28479160 DOI: 10.1053/j.jfas.2017.01.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Indexed: 02/03/2023]
Abstract
Scarf osteotomy is a common operative procedure for mild-to-moderate hallux valgus. We describe a simple supportive technique that prevents troughing intraoperatively without additional bony procedures.
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Affiliation(s)
- Su Chan Lee
- Orthopedist, Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Korea
| | - Seung Hyun Hwang
- Orthopedist, Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Korea.
| | - Chang Hyun Nam
- Orthopedist, Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Korea
| | - Ji-Hoon Baek
- Orthopedist, Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Korea
| | - Soon Yong Yoo
- Orthopedist, Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Korea
| | - Hye Sun Ahn
- Research Fellow, Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Korea
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Abstract
Hallux valgus is one of the most common deformities of the lower extremity. Multiple etiologies have been discussed, and various techniques have been described. The SCARF osteotomy is indicated for moderate to severe hallux valgus deformities. The technique historically used by carpenters allows immediate postoperative weight bearing and also entails the possibility to correct the distal metatarsal articular angle by rotation of the osteotomy. The SCARF osteotomy has also been successfully used in revision surgeries.
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Affiliation(s)
- H-J Trnka
- Fusszentrum Wien, Alserstraße 43/8d, 1080, Wien, Österreich.
| | - P Bock
- Fusszentrum Wien, Alserstraße 43/8d, 1080, Wien, Österreich
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26
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Kim JS, Cho HK, Young KW, Lee SY, Kim JS, Lee K. Effectiveness of Headless Bioabsorbable Screws for Fixation of the Scarf Osteotomy. Foot Ankle Int 2016; 37:1189-1196. [PMID: 27672017 DOI: 10.1177/1071100716661826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scarf osteotomy has been used in hallux valgus surgery due to its large fixation surface for screws and low postoperative complications. However, screws may cause skin irritation from their head, which may require an additional surgical procedure to remove. METHODS This study included 115 patients (106 females and 9 males, 115 feet) who underwent hallux valgus correction with a scarf osteotomy using bioabsorbable screws between September 2010 and September 2012. Preoperative and postoperative 1-month and 1-year radiographic measurements, including intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA), and lateral translational distance (LTD), were obtained. American Orthopaedic Foot & Ankle Society (AOFAS) hallux/forefoot scores were used for patient satisfaction. RESULTS Preoperative mean values of HVA, IMA, and PPA of 32.8 degrees, 14.6 degrees, and 7.52 degrees, respectively, improved to 10.7 degrees, 6.0 degrees, and 4.6 degrees, respectively at 1-year follow up (P < .05). The difference in LTD between the 1-month and 1-year follow-up was not statistically significant. AOFAS hallux/forefoot score improved from 69.1 to 96.1 at the 1-year follow up (P < .001). Complete screw absorption was not seen radiographically. Sixteen feet had complications reported. One patient complained of skin irritation over a small protrusion of the screw, and another patient had a foreign body reaction. There were 3 patients with neurologic injury from a popliteal block and 3 patients with dorsal cutaneous nerve symptoms. Four feet had metatarsal fracture during surgery. CONCLUSION We found the scarf osteotomy using bioabsorbable screws to have satisfactory clinical and radiographic results with a low complication rate. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Jin Su Kim
- Surgery of Foot and Ankle, CM chungmu general hospital, Yeongdeuon-po, Seoul, Republic of Korea
| | - Hun Ki Cho
- Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea
| | - Ki Won Young
- Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea
| | - Sang Young Lee
- Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea
| | - Ji Soo Kim
- Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea
| | - Kyoungtae Lee
- KT Lee's Orthopedic Hospital, Seoul, Republic of Korea
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27
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Boychenko AV, Solomin LN, Parfeyev SG, Obukhov IE, Belokrylova MS, Davidov DV. Efficacy of Bilateral Simultaneous Hallux Valgus Correction Compared to Unilateral. Foot Ankle Int 2015; 36:1339-43. [PMID: 26109607 DOI: 10.1177/1071100715589174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus affects up to 29% of adults and can be bilateral in 84% of cases. Contemporary surgical techniques provide the possibility of simultaneous bilateral correction, but still there is no consensus on whether staged or simultaneous correction should be performed if both feet are involved. The aim of the present study was to report our experience of treatment of patients with hallux valgus and to perform comparative analysis of results obtained from unilateral and simultaneous bilateral surgical correction. METHODS Data on 60 feet (40 patients) with hallux valgus that underwent surgery between 2010 and 2013 using scarf osteotomy and lateral soft tissue release were analyzed. Unilateral correction was performed in 30 feet (25 patients) and bilateral correction in 30 feet (15 patients). The patients from both groups were admitted to hospital for 7 days. Functional assessment (American Orthopaedic Foot & Ankle Society [AOFAS] score) and radiographic examination (intermetatarsal and hallux valgus angles) were performed preoperatively and at 6, 12, and 24 months after the procedure. Comparative analysis between groups with bilateral and unilateral correction was carried out. RESULTS At 24 months after surgery in the bilateral and unilateral groups, the mean AOFAS score was 86 ± 6.2 and 86 ± 6.9 (P > .05), the mean intermetatarsal angle was 8.4 ± 0.5 and 8.8 ± 0.8 degrees (P > .05), and the mean metatarsophalangeal angle was 13.0 ± 1.2 and 13.0 ± 0.9 degrees (P > .05), respectively. CONCLUSION According to the data obtained, simultaneous bilateral correction had the same functional and radiographic results as unilateral surgery. LEVEL OF EVIDENCE Level III, case series.
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Affiliation(s)
- Anton Viktorovich Boychenko
- St Petersburg State University, Faculty of Medicine, General Surgery Department, St Petersburg, Russian Federation City Hospital No. 2, St Petersburg, Russian Federation
| | - Leonid Nikolaevich Solomin
- St Petersburg State University, Faculty of Medicine, General Surgery Department, St Petersburg, Russian Federation Vreden Russian Research Institute of Traumatology and Orthopedics, Ministry of Health, St Petersburg, Russian Federation
| | - Sergey Gennadievich Parfeyev
- St Petersburg State University, Faculty of Medicine, General Surgery Department, St Petersburg, Russian Federation City Hospital No. 2, St Petersburg, Russian Federation
| | | | - Maria Sergeevna Belokrylova
- St Petersburg State University, Faculty of Medicine, General Surgery Department, St Petersburg, Russian Federation
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28
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Abstract
BACKGROUND The technique of double first metatarsal osteotomies was first developed in response to the high frequency of recurrence noted in the treatment of severe adolescent congruent hallux valgus deformities. The concept behind the use of this technique is that it allows the individual correction of each component of the deformity. We have modified the technique for use in adult hallux valgus where the majority of deformities are incongruent deformities and the distal chevron osteotomy is used primarily for its additional translational properties rather than purely to correct the distal metatarsal articular angle (DMAA). We report on a series of double first metatarsal osteotomies (basal opening wedge and distal chevron osteotomy) with Akin osteotomy in the treatment of moderate to severe adult hallux valgus deformity. METHODS All patients presenting to our institution with a hallux valgus deformity and treated with this procedure between 2008 and 2013 with a minimum of 1 year of follow-up were identified. Data were obtained through review of case notes, electronic charts, and digital imaging. A total of 50 feet in 48 patients underwent double first metatarsal osteotomy with Akin osteotomy. Three patients were excluded due to loss to follow-up, leaving 47 feet in 45 patients with a mean follow-up of 45 months (range, 14-60 months). Of these 43 (96%) were female and the mean age was 56 years (range, 35-70 years). RESULTS The mean preoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), DMAA, sesamoid position, and lateral first metatarsotalar angle were 42 degrees (range, 32-52 degrees), 18 degrees (range, 6-26 degrees), 12 degrees (range, 4-26 degrees), stage 6 (range, 4-7), and 2 degrees of dorsiflexion (range, 20 degrees of dorsiflexion to 4 degrees of plantar flexion), respectively. The mean postoperative HVA, IMA, DMAA, sesamoid position, and lateral first metatarsotalar angle were 7 degrees (range, 2 to 24 degrees), 4 degrees (range, 4-14 degrees), 6 degrees (range, 10-22 degrees), stage 2 (range, 1-5) and 6 degrees of plantar flexion (range, 8 degrees of dorsiflexion to 18 degrees of plantar flexion), respectively. The osteotomies consolidated at a mean of 7 weeks (range, 5-9 weeks). There were no cases of delayed union or nonunion. Of the cohort, 45 (96%) stated that they were satisfied overall with the results of their surgery and would have it again. The mean postoperative summary index Manchester-Oxford Foot Questionnaire (MOXFQ) score was 12.9 (range, 0-60.9) out of 100 at a mean follow-up of 45 months (range, 14-60 months). For the minority of cases, 8 (17%), that had preoperative scoring, the summary index MOXFQ score was 73.7 (range, 29.7-100). CONCLUSIONS The double first metatarsal osteotomy (basal opening wedge and distal chevron osteotomy) with Akin osteotomy provides powerful correction and facilitates correction of the individual components of the hallux valgus deformity. The individual osteotomies that make up this procedure are familiar to the majority of foot and ankle surgeons, thus limiting the associated learning curve. LEVEL OF EVIDENCE Level IV, retrospective case series.
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29
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Bock P, Kluger R, Kristen KH, Mittlböck M, Schuh R, Trnka HJ. The Scarf Osteotomy with Minimally Invasive Lateral Release for Treatment of Hallux Valgus Deformity: Intermediate and Long-Term Results. J Bone Joint Surg Am 2015; 97:1238-45. [PMID: 26246258 DOI: 10.2106/jbjs.n.00971] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the long-term results of surgical correction of hallux valgus deformity, in particular, the recurrence rate and factors leading to recurrence. METHODS Of one hundred and eight patients (115 feet) who underwent a Scarf osteotomy, ninety-three patients (ninety-three feet) were examined at an average duration of follow-up of 124 months. Clinical examination before surgery and at the time of final follow-up included an evaluation of range of motion, pain as measured with a visual analog scale, and American Orthopaedic Foot & Ankle Society (AOFAS) scores. The Foot and Ankle Outcome Score (FAOS) was also assessed postoperatively. Radiographic data were evaluated preoperatively, at six weeks postoperatively, and at the time of final follow-up. Additional radiographic data were available for seventy-nine patients of the same patient cohort at an average of twenty-seven months postoperatively. RESULTS The median overall AOFAS score improved from 57 points preoperatively to 95 points at the time of final follow-up. All radiographic measurements (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], and sesamoid bone position) showed significant (p < 0.05) improvement at the time of final follow-up compared with preoperatively. The rate of recurrence (an HVA of ≥20°) at the time of final follow-up was 30%. We were unable to determine if recurrence resulted in functional impairment or consequences for quality of life. CONCLUSIONS The recurrence rate after ten years was 30%, and a higher final HVA resulted in higher pain levels. The limitations imposed by nonvalidated outcome measures precluded conclusions about the influence of HVA on function or quality of life.
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Affiliation(s)
- Peter Bock
- Orthopedic Hospital Wien Speising, Speisinger Strasse 109, 1130 Vienna, Austria. E-mail address for P. Bock:
| | - Rainer Kluger
- Danube Hospital Vienna, Langobardenstrasse 122, 1220 Vienna, Austria
| | | | - Martina Mittlböck
- Department of Clinical Biometrics, Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Reinhard Schuh
- Department of Orthopaedics, University Clinics Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Hans-Joerg Trnka
- Orthopedic Hospital Wien Speising, Speisinger Strasse 109, 1130 Vienna, Austria. E-mail address for P. Bock:
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30
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Kin-Wing L, Alwin LHY, Pang-Hei L, Jid-Lee Q, Yuk-Leung W. Scarf Osteotomy in Treating Hallux Valgus: Clinical and Radiographical Outcome and Technical Notes. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2014. [DOI: 10.1016/j.jotr.2014.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Scarf osteotomy can be a technically demanding procedure and early reports have shown high complication rates. Proponents, however, suggest that this type of osteotomy is versatile and allows for both translation and angulation correction of the hallux valgus (HV) deformity. The purpose of this study was to evaluate the clinical and radiological results of the scarf osteotomy procedure performed in our hospital. Materials and methods We retrospectively reviewed 31 feet in 25 patients with an average follow-up duration of 16 months (range: 6–30 months). Results On the latest follow up, 77% of the patients were satisfied with the result, with an average postoperative American Orthopaedic Foot and Ankle Society score of 88. The average improvement of HV angle was from 37.9° to 10.0°. The intermetatarsal angle improved from 16.0° to 8.0°. The average first metatarsal shortening was 0.3 mm. Neither delayed union nor osteonecrosis was observed. Conclusion Scarf osteotomy is a reliable procedure to achieve correction of HV deformity with good patient satisfaction.
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Affiliation(s)
- Law Kin-Wing
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Hong Kong SAR, China
| | - Li Hok-Yin Alwin
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Hong Kong SAR, China
| | - Li Pang-Hei
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Hong Kong SAR, China
| | - Qunn Jid-Lee
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Hong Kong SAR, China
| | - Wai Yuk-Leung
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Hong Kong SAR, China
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Giannini S, Faldini C, Nanni M, Di Martino A, Luciani D, Vannini F. Reply to comments by Wu et al. regarding our manuscript titled: A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI). INTERNATIONAL ORTHOPAEDICS 2013; 38:673-4. [PMID: 24337798 DOI: 10.1007/s00264-013-2217-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Sandro Giannini
- I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
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Deveci A, Firat A, Yilmaz S, Oken OF, Yildirim AO, Ucaner A, Bozkurt M. Short-term clinical and radiologic results of the scarf osteotomy: what factors contribute to recurrence? J Foot Ankle Surg 2013; 52:771-5. [PMID: 23663877 DOI: 10.1053/j.jfas.2013.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Indexed: 02/08/2023]
Abstract
The present retrospective investigation aimed to determine the factors associated with recurrence of hallux valgus deformity after scarf osteotomy in 50 feet in 43 consecutive patients. We hypothesized that hallux abductovalgus after scarf osteotomy recurs because of the presence of preoperative joint incongruity. The clinical and radiographic findings, including the weightbearing radiographic hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, first metatarsophalangeal joint congruence, American Orthopaedic Foot and Ankle Society scores, and pain measured on a visual analog scale, and logistic regression analysis were used to analyze the association of the independent variables with the recurrence of deformity. The mean age of the patients was 47.7 (range 21 to 65) years, and the mean follow-up duration was 26.2 (range 18 to 36) months. The mean American Orthopaedic Foot and Ankle Society scores improved from 50.7 ± 4.9 to 88.7 ± 7.9, and the visual analog scale pain scores improved from 7.5 ± 1.1 to 2.4 ± 1.0 (p < .05). The changes in the radiographic measurements were also statistically significant. Of the 50 feet, 5 (10%) developed recurrent hallux abductovalgus, each of which occurred in feet that had displayed a first metatarsophalangeal joint incongruity on preoperative radiographs. The incongruity was observed to be a statistically significant risk factor for recurrence according to the regression models. From our experience with the patients analyzed in the present report, we believe that first metatarsophalangeal joint congruity should be given particular attention when surgical correction of hallux abductovalgus is undertaken.
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Affiliation(s)
- Alper Deveci
- Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
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33
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Choi JH, Zide JR, Coleman SC, Brodsky JW. Prospective study of the treatment of adult primary hallux valgus with scarf osteotomy and soft tissue realignment. Foot Ankle Int 2013; 34:684-90. [PMID: 23637236 DOI: 10.1177/1071100712472489] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The scarf osteotomy has been a widely practiced bunion operation, but relatively limited prospective data on its outcomes have been reported. The purpose of this investigation was to prospectively evaluate the clinical and radiographic results of treatment of adult primary hallux valgus using the scarf osteotomy of the first metatarsal with soft tissue realignment. METHODS Hallux valgus corrections were performed on 51 patients (53 feet), who were followed for at least 1 year with an average follow-up of 24 months. Mean age at the time of surgery was 59 years, and subjects included 3 male and 48 female patients. Prospective clinical data collected included the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-interphalangeal scale score, the SF-36 scores, and the visual analogue scale (VAS) for pain. Data were collected preoperatively and postoperatively. Prospective radiologic data were also collected including hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), and medial sesamoid position (MSP). Clinical data were collected on complications and reoperations. RESULTS Mean AOFAS hallux-interphalangeal score increased from 52 preoperatively to 88 postoperatively. Mean preoperative and last follow-up SF-36 physical component summary increased from 46 preoperatively to 52 postoperatively, whereas mean VAS pain scores decreased from 5.8 preoperatively to 1.1 postoperatively. All the changes in clinical outcomes were statistically significant, except the Mental Component Summary of the SF-36. Mean preoperative HVA decreased from 29 degrees preoperatively to 10.7 degrees in the initial postoperative period and was maintained at last follow-up at 10.6 degrees. The mean preoperative IMA decreased from 13.6 degrees preoperatively to 5.6 degrees in the initial postoperative period and regressed mildly at last follow-up to 7.8 degrees. The mean preoperative MSP grade of 2.3 decreased to 0.5 in the initial postoperative period and regressed mildly to 0.9 at last follow-up. All radiographic changes were statistically significant. The overall complication rate was 15% (8/53), attributable to 4 feet with symptomatic hardware, 2 feet with hallux varus, and 2 feet with progression of first MTP arthritis. Reoperations were performed in 4 feet (8%) for removal of symptomatic hardware. CONCLUSION Scarf osteotomy was a reliable technique for correction of moderate to severe hallux valgus and had low rates of complication or recurrence. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Jae Hyuck Choi
- Baylor University Medical Center, Dallas, Texas 75246, USA
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34
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Minimally invasive distal linear metatarsal osteotomy for correction of hallux valgus: a preliminary study of clinical outcome and analytical radiographic results via a mapping system. Arch Orthop Trauma Surg 2013; 133:321-31. [PMID: 23224562 DOI: 10.1007/s00402-012-1665-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Indexed: 11/27/2022]
Abstract
PURPOSES To date, actual results of a minimally invasive distal linear metatarsal osteotomy (DLMO) via more explicit radiographic delineation are poorly understood and radiographic findings and clinical results have not been systematically correlated. Purposes of this study were (1) to evaluate the effectiveness of DLMO using a precise radiographic mapping system; and (2) to determine the relationship between radiographic outcomes and clinical results. MATERIALS AND METHODS In 2008-2011, DLMO was performed in 30 patients (36 feet) who had reducible symptomatic hallux valgus. Clinical data were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographs were reviewed at preoperative and final follow-up for delineations of first ray construct, hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and other radiographic profiles. Correlation between postoperative AOFAS score and degree of malalignment was also analyzed. RESULTS A total of 36 feet had predominantly moderate hallux valgus (26 feet with HVA: 21-39°; 23 feet with IMA: 12-17°). Mean preoperative and postoperative AOFAS scores were 70.2 ± 11.3 and 95 ± 6.4, respectively (p < 0.001). Mapping system revealed improvements of first ray construct deformity (p < 0.05). Significant reductions in all angular measurements were observed at final follow-up period (p < 0.001) and correlated significantly with changes in AOFAS score (p < 0.001). Nine feet (25 %) were observed with recurrence of deformity which showed HVA >15°. Significant sesamoid lateralization was observed (p < 0.05). Twenty-four feet (66.7 %) showing overall sagittal malunions were found with significant plantar angulation (p = 0.026) and non-significant plantar displacement compared with preoperative reference (p = 0.43). These radiographic abnormalities were not related to clinical outcomes including postoperative AOFAS scores (p > 0.05). CONCLUSION DLMO is an acceptable procedure to correct reducible hallux valgus in most patients with moderate level of severity. Sagittal malunion, recurrence, and sesamoid lateralization are possibly radiographic abnormalities but are not associated with clinical impairments.
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35
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Abstract
Efforts are currently being made to improve results in hallux valgus treatment. Different studies to design procedures that are more stable and efficient to correct deformities are underway, and new techniques will be presented in the following years. Better fixation devices will offer reliability in corrections, and hopefully will allow faster rehabilitation with fewer restrictions. Understanding the concept of correction power is important when deciding which technique to use. The origin of hallux valgus is not known, but evidence exists to assume that a correct skeletal and soft tissue balance is important to prevent recurrence and obtain good function. We think that a correct metatarsophalangeal reduction, in which the final position of the hallux is defined mainly by the skeletal alignment and not soft tissues, will dictate the final result. Pushing the metatarsal bone over the sesamoids and not moving the sesamoids under the metatarsal head is a new concept and it may allow better results for our patients. It is hoped that understanding of biomechanics will continue to evolve, and radiological measurements and corrections will produce better functional results for patients.
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Affiliation(s)
- Emilio Wagner
- Clinica Alemana, Departamento de Traumatologia y Ortopedia, Vitacura, Santiago, Chile.
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36
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Mathew PG, Sponer P, Pavlata J, Shaikh HH. Our experience with double metatarsal osteotomy in the treatment of hallux valgus. ACTA MEDICA (HRADEC KRÁLOVÉ) 2012; 55:37-41. [PMID: 22696934 DOI: 10.14712/18059694.2015.73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Adolescent hallux valgus (HV) is a progressive deformity of adolescent age consisting of metatarsus primus varus and hallux valgus. It has a high recurrence rate after conventional surgical correction. Ten feet in nine patients (two males, seven females) were treated surgically with the Peterson Newman bunion procedure, with a minimum follow-up of one year. During the final follow-up all these patients had no complaints of pain, joint stiffness or limping. Even though the patients had some mild loss of range of movements at the MTPjoints 4-6 degrees compared to preoperative value, it did not cause any functional impairment and all were satisfied with the final outcome. The double ostetomy for treatment ofhallux valgus is technically precise procedure, provides excellent correction and stability and has low rate of recurrence of deformity. We had an excellent outcome in 10 feet in our study without residual deformity or complications.
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Affiliation(s)
- Pradeep George Mathew
- Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Czech Republic.
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