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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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The Minimally Invasive SERI Osteotomy for Pediatric Hallux Valgus. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010094. [PMID: 36670645 PMCID: PMC9856383 DOI: 10.3390/children10010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
Hallux valgus (HV), one of the most common forefoot pediatric pathologies, is characterized by lateral deviation of the big toe and medial displacement of the first metatarsal bone. Different surgical techniques have been described to correct the deformity, but no consensus has been reached regarding the best surgical option. The aim of this retrospective study was to report the results of the SERI technique in 58 pediatric HV of 45 consecutive patients. Pre- and postoperative VAS, AOFAS score, HVA, IMA and DMAA were collected. Preoperatively 3 patients (5.2%) had a mild deformity, 52 patients (89.6%) had moderate deformity and 3 patients (5.2%) had severe deformity according to Coughlin et al. Mean VAS score decreased from 5.2 ± 2.2 preoperatively to 0.8 ± 0.4 postoperatively. Mean AOFAS score improved from 68.1 ± 6.8 (range 59−75) preoperatively to 96.3 ± 3.2 (range 88−100) postoperatively, mean HVA reduced from 28.4° preoperatively to 13.2° postoperatively, mean IMA decreased from 15.2° preoperatively to 9.5° postoperatively (p < 0.01); mean DMAA decreased from 13.7° preoperatively to 8.2° postoperatively (p < 0.01). SERI technique showed satisfactory results when treating mild to severe pediatric HV deformity. No major complications were reported.
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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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Clee S, Flanagan G, Pavier J, Reilly I. Correction of hallux abducto valgus by scarf osteotomy. A ten-year retrospective multicentre review of patient reported outcomes shows high satisfaction rates with podiatric surgery. J Foot Ankle Res 2022; 15:44. [PMID: 35650635 PMCID: PMC9159929 DOI: 10.1186/s13047-022-00546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Corrective surgery for hallux abducto valgus is one of the most performed elective procedures in foot and ankle practice. Numerous methods of surgical correction have been reported within the literature, with varying clinical and patient reported outcomes. This study reviews the patient experience and outcomes in five podiatric surgery centres using the scarf diaphyseal osteotomy. METHOD Patient reported outcome measures (PROMs) were captured using the Patient Satisfaction Questionnaire 10 (PSQ-10), part of the PASCOM-10 podiatric surgery audit tool. PROMs were collated across five hospital sites over a 10-year period. RESULTS Of 1351 patients reported during the period, 1189 had complete retrospective data. The most common patient aim of surgery was 'no/less pain' reported in 70% of patients. 96.8% of patients reported their original foot complaint as 'better' or 'much better' after surgery. 92.8% of patients reported their expectations had been met with 96.6% reporting they would have surgery again under the same conditions. 98.5% of patients noted that the risks, complications, and expectations had been discussed prior to surgery. The most common complication was metatarsal fracture (4.6%). CONCLUSION The scarf osteotomy (with or without an Akin phalangeal osteotomy) consistently showed high patient satisfaction with low complication rates using PSQ-10 and this information can be used as part of the pre-operative consenting process. Patient expectations for surgery were often achieved, which may be attributed to the pre-operative work up of the patient. Further investigation into this correlation is suggested. LEVEL OF CLINICAL EVIDENCE IV (retrospective review).
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Affiliation(s)
- Sharon Clee
- Department of Podiatric Surgery, Northamptonshire Healthcare NHS Foundation Trust (NHFT), Northampton, UK
- Department of Podiatric Surgery Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Private Practice, The Park Hospital, Nottingham; and Circle Nottingham, Nottingham, UK
| | - George Flanagan
- Department of Podiatric Surgery, Northamptonshire Healthcare NHS Foundation Trust (NHFT), Northampton, UK
- Private Practice, Three Shires Hospital Northampton, Northamptonshire, UK
| | - Julian Pavier
- Department of Podiatric Surgery Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Private Practice, The Park Hospital, Nottingham; and Circle Nottingham, Nottingham, UK
| | - Ian Reilly
- Department of Podiatric Surgery, Northamptonshire Healthcare NHS Foundation Trust (NHFT), Northampton, UK
- Private Practice, Three Shires Hospital Northampton, Northamptonshire, UK
- Private Practice, Ramsay Woodlands Hospital, Kettering, Northamptonshire UK
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Matthews M, Klein E, Youssef A, Weil L, Sorensen M, Weil LS, Fleischer A. Correlation of Radiographic Measurements With Patient-Centered Outcomes in Hallux Valgus Surgery. Foot Ankle Int 2018; 39:1416-1422. [PMID: 30136598 DOI: 10.1177/1071100718790255] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Evaluation of patients undergoing hallux valgus surgery has historically emphasized radiographic angles and relationships. However, patient-reported outcomes are increasingly important as health care systems trend towards a "value-based" delivery approach. METHODS: We conducted a retrospective analysis of pre-existing data in our practice to examine whether patient-reported outcomes after bunion surgery, determined via Foot and Ankle Outcome Scores (FAOS), correlated with radiographic parameters commonly measured in hallux valgus deformity. Pearson correlation statistics and simple and multiple linear regression models were used to identify important radiographic predictors. There were 80 patients (80 feet) with mean follow-up of 59.3 ± 11.6 weeks (median 55, range 45.7-96.3 weeks) with complete data. RESULTS: No radiographic measurement/variable achieved anything more than a weak correlation with any of the FAOS subscale scores at final follow-up; the study's best was postoperative first-second intermetatarsal (IM) angle with sports and recreation scores ( r = -0.328, P = .005). There was no correlation found between change in hallux valgus angle, change in first-second IM angle, magnitude of preoperative hallux valgus angle or magnitude of preoperative first-second IM angle ( P > .05 for all). Furthermore, none of the study's final multivariable models achieved an R2 > 0.24, and nearly all fell between 0.10 and 0.17. CONCLUSION: We conclude that radiographic angles were not well correlated with patient-centered outcomes in hallux valgus surgery. This study calls into question the current emphasis that is placed on x-ray values both pre- and postoperatively. LEVEL OF CLINICAL EVIDENCE: Level III, comparative study.
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Affiliation(s)
| | - Erin Klein
- 1 Weil Foot and Ankle Institute, Des Plaines, IL, USA
| | - Angie Youssef
- 1 Weil Foot and Ankle Institute, Des Plaines, IL, USA
| | - Lowell Weil
- 1 Weil Foot and Ankle Institute, Des Plaines, IL, USA
| | | | - Lowell S Weil
- 1 Weil Foot and Ankle Institute, Des Plaines, IL, USA
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Tenenbaum SA, Herman A, Bruck N, Bariteau JT, Thein R, Coifman O. Foot Width Changes Following Hallux Valgus Surgery. Foot Ankle Int 2018; 39:1272-1277. [PMID: 29952666 DOI: 10.1177/1071100718783458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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 (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. MATERIALS AND METHODS 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). RESULTS 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. CONCLUSION 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 OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Shay A Tenenbaum
- 1 Department of Orthopedic Surgery, Chaim Sheba medical center at Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Herman
- 2 Department of Orthopaedic Surgery, Assuta Ashdod, Ashdod, Israel; affiliated to Bear Sheva university, Bear Sheva, Israel
| | - Nathan Bruck
- 1 Department of Orthopedic Surgery, Chaim Sheba medical center at Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jason T Bariteau
- 3 Department of Orthopedics, Emory University School Medicine, Atlanta, GA, USA
| | - Ran Thein
- 1 Department of Orthopedic Surgery, Chaim Sheba medical center at Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Coifman
- 1 Department of Orthopedic Surgery, Chaim Sheba medical center at Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Milczarek MA, Milczarek JJ, Tomasik B, Łaganowski P, Nowak K, Domżalski M. Being overweight has limited effect on SCARF osteotomy outcome for hallux valgus correction. INTERNATIONAL ORTHOPAEDICS 2017; 41:765-772. [DOI: 10.1007/s00264-017-3419-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
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Abstract
We present a discussion on the use of proximal first-ray osteotomies in the surgical treatment for hallux valgus as a valid option compared with first-tarsometatarsal arthrodesis. Recent and historical literature tells us that stability of the first ray is a function of the alignment and reestablishment of retrograde stabilizing forces at the first tarsometatarsal joint. This realignment and stabilization may be accomplished with the use of distal soft tissue and proximal osteotomy procedures.
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Affiliation(s)
- Matthew D Sorensen
- Weil Foot & Ankle Institute, Golf River Professional Building, 1455 East Golf Road, Des Plaines, IL 60016, USA.
| | - Brian Gradisek
- Weil Foot & Ankle Institute, Golf River Professional Building, 1455 East Golf Road, Des Plaines, IL 60016, USA
| | - James M Cottom
- Coastal Orthopedics and Sports Medicine, Bradenton, FL, USA
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