Scarf osteotomy for hallux valgus deformity: Radiological outcome, metatarsal length and early complications in 118 feet (original) (raw)
Related papers
Distal Oblique Metatarsal Osteotomy for Hallux Valgus Deformity: A Clinical Analysis
The Journal of Foot and Ankle Surgery, 2017
We compared the outcomes of the distal oblique metatarsal (DOM) osteotomy, which is parallel to the articulation surface of the proximal phalanx, with those of the Chevron osteotomy and evaluated whether displacement and shortening of the first metatarsal have any effect on the incidence of metatarsalgia and patient satisfaction. Patients treated with the DOM osteotomy (n ¼ 30) or distal Chevron osteotomy (n ¼ 31) were evaluated retrospectively. The Chevron and DOM osteotomies both provided significant improvement in the first intermetatarsal angle (p < .001), hallux valgus angle (p < .001), distal metatarsal articular angle (p < .001), range of first metatarsophalangeal joint motion (p < .001), American Orthopaedic Foot and Ankle Society score (p < .001), and sesamoid position (p < .001), without any significant differences between the 2 groups. Patient satisfaction and metatarsalgia also were not different between the study groups. The DOM osteotomy group had higher plantar displacement (0.1 AE 0.1 mm versus 1.0 AE 0.1 mm; p < .001) and absolute shortening of the first metatarsal (1.0 AE 0.4 mm versus 6.8 AE 1.0 mm; p < .001). In conclusion, the DOM osteotomy is an alternative treatment method for mild and moderate hallux valgus.
A radiographic evaluation of the scarf osteotomy for the correction of hallux valgus
Foot and Ankle Surgery, 2004
A prospective radiographic study was performed on 13 patients (22 ft) undergoing SCARF osteotomy with an average age of 52 years (range, 25-78). Standardised weight bearing anterior-posterior radiographs were taken preoperatively and at 6 months post-operatively. These were compared to determine changes in the intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA) and joint congruency angle (JCA). Correction of sesamoid position and metatarsal length changes were also assessed. The results showed a median reduction of IMA of 68, HVA of 168, DMAA of 68 and an improvement in JCA of 118. Improvement of medial sesamoid displacement beneath the first metatarsal head was seen post-operatively. Metatarsal length was assessed by comparing the ratio of the length of the first to second metatarsal pre and post-operatively. No shortening was found. There was no incidence of avascular necrosis or delayed union. This study indicates that the SCARF osteotomy produces effective radiological correction of hallux valgus. It corrects sesamoid displacement and avoids shortening of the first metatarsal.
Acta Orthopaedica Belgica, 2009
This study aimed to investigate the preliminary results achieved with a modified distal first metatarsal osteotomy (reversed L-shaped) for correction of moderate and severe hallux valgus deformities. This prospective study included 31 patients (39 feet) with a mean age of 56 years. All patients underwent a reversed L-shaped osteotomy of the first metatarsal. At follow-up all patients were reviewed clinically and radiologically. Patients were categorized into two groups (MTP angle A : < 20°, and B : 20-40°). The AOFAS score improved from 53 points to 91 points at follow-up (p < 0.0001). Group A showed an increase from 56 to 90 points (p = 0.003), group B from 52 to 92 points (p < 0.0001). The mean 1-2-intermetarsal angle (IMA) decreased from 12.5° preoperatively to 8° at follow-up (p < 0.005) : from from 11°t o 9° in group A (p = 0.09) and from from 13° to 7° in Group B (p < 0.0001). No nonunion or avascular necrosis was observed. One diabetic patient developed a resistant postoperative infection. The L-shaped osteotomy provided good and excellent clinical as well as radiological results in the mild and moderate-to-severe hallux valgus deformities treated. The mid-and long-term effect of this type of osteotomy needs to be further investigated.
Correction of moderate to severe hallux valgus with isometric first metatarsal double osteotomy
Foot & ankle international, 2014
The operative treatment for the moderate to severe bunion continues to present challenges. The indications for a single, double, or triple first ray osteotomy remain controversial. In addition, it is not clear whether an opening wedge osteotomy leads to clinically relevant arthritis at the first metatarsophalangeal joint. However, it is this theoretical concern that has led the authors to develop an isometric correction of the first ray. Thirty-two patients underwent operative correction of hallux valgus with a double osteotomy of the first metatarsal using an opening wedge proximally and a closing wedge distally. The mean follow-up period was 59.3 months with a range of 55 to 65 months. The 1-2 intermetatarsal angle preoperatively was a mean of 18.9 degrees (range 17-23), correcting postoperatively to a mean angle of 8.6 degrees (range 5-12), for an average correction of 10.4 degrees (range 6-16). The postoperative AOFAS scores were 39.4 out of 40 points for pain, 42.4 out of 45 po...
Radiographic Evaluation of Minimally Invasive Distal Metatarsal Osteotomy for Hallux Valgus
Foot & Ankle International, 2011
Background:The use of minimally invasive surgical technique for hallux valgus is controversial. The purpose of this study was to retrospectively evaluate the radiographic results of a minimally invasive distal metatarsal osteotomy for correction of hallux valgus.Materials and Methods:From September 2005 to March 2008, a minimally invasive distal metatarsal osteotomy was performed in 82 patients (125 feet) for hallux valgus. The average age was 40.8 (range, 13 to 71) years. The mean followup period was 18.3 (range, 9 to 38) months. These patients were categorized into groups based on their gender, age, preoperative hallux valgus angle, and preoperative 1–2 intermetatarsal angle. The radiographs were reviewed for preoperative and final followup hallux valgus angle, 1–2 intermetatarsal angle, and malunion or nonunion. A final followup hallux valgus angle greater than 20 degrees was defined as “recurrence of deformity” and represented a poor radiographic result.Results:There were no non...
Yonsei medical journal, 2015
The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy. We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation. Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 group...
Distal Metatarsal Osteotomy for Correction of Hallux Valgus
Orthopedics and Rheumatology Open Access Journal, 2017
Objective: To evaluate the experience acquired in hallux valgus correction with percutaneous distal metatarsal osteotomy. Material and Methods: Between January 2012 and July 2016, distal osteotomy of the first metatarsal with lateral displacement has been used in the treatment of 10 patients with hallux valgus. Five patients had bilateral operation done, making up a total of 15 feet. The clinical evaluation of results after surgery using the American Orthopaedic Foot and Ankle Society (AOFAS) scale, the intermetatarsal angle and the hallux valgus angle were also recorded. Results: All patients reported the disappearance or reduction of pain over the first metatarsal (MT) heads after the operation. A mean improvement of total score from 56.06 points to 90.3 points was achieved in the 15 feet operated. Except one foot with fair result, all the rest of the patients (93.3%) had excellent to good to excellent result. There were no instances of nonunion, malunion, avascular necrosis of the metatarsal head, or recurrence of hallux valgus. Conclusion: The distal metatarsal osteotomy and lateral displacement with K-wire stabilization offered a reliable, reproducible, simple, safe, and cost-effective way of treating hallux valgus deformity.
The European Research Journal, 2017
Objective. The aim of this study was to compare the clinical and radiological results of Mau osteotomy and Scarf osteotomy with a modified McBride procedure to patients with moderate to severe hallux valgus deformity. Methods. The study included 40 feet which patients were separated into 2 groups followed up for 5 months. Scarf osteotomy was applied to 20 patients including 16 females and 4 males (Scarf group)) and a Mau osteotomy to 20 patients including 17 females and 3 males (Mau group). Radiological measurements were taken preoperative, postoperative and at the final follow-up examination of the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), metatarsocuneiform angle (MCA), the 1st metatarsophalangeal joint congruity, 1st metatarsal length, fibular sesamoid subluxation rate. Clinical evaluation was made according to the American Orthopaedic Foot and Ankle Society (AOFAS) and the severity of pain was assessed with the visual analog scale (VAS). Results. There was no difference between the groups in term of the mean HVA, IMA, MCA and DMAA values in preoperative and postoperative measurements. A significant improvement was determined in all the angle values in Scarf and Mau group (p<0.001). A significant increase in DMAA and shortening in the metatarsal length were determined in Mau group compared to Scarf group (p<0.001). An improvement in joint congruity was seen in the goups (p<0.001). There was a significant improvement in term of the AOFAS and VAS values in the groups (p<0.001). Conclusion. Scarf and Mau osteotomies can provide the desired level of improvement in the short-term follow-up results of moderate to severe hallux valgus deformity, taking into consideration the clinical importance that complications are not formed.
Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus
The Journal of Bone and Joint Surgery (American), 2005
Background: Distal osteotomy of the first metatarsal is indicated for the surgical treatment of mild-to-moderate hallux valgus deformity. The aim of this study was to evaluate the results of a subcapital distal osteotomy of the first metatarsal with use of a percutaneous technique. Methods: From 1996 to 2001, 118 consecutive percutaneous distal osteotomies of the first metatarsal were performed for the treatment of painful mild-to-moderate hallux valgus in eighty-two patients. The patients were assessed with a clinical and radiographic protocol at a mean of 35.9 months postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale was used for the clinical assessment. Results: The patients were satisfied following 107 (91%) of the 118 procedures. The mean score on the AOFAS scale was 88.2 ± 12.9 points. The postoperative radiographic assessments showed a significant change (p < 0.05), compared with the preoperative values, in the mean hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, and sesamoid position. The valgus deformity recurred after three procedures (2.5%), the first metatarsophalangeal joint was stiff but not painful after eight (6.8%), and a deep infection developed after one (0.8%). The infection resolved with antibiotic therapy. Conclusions: The percutaneous technique proved to be reliable for the correct execution of a distal linear osteotomy of the first metatarsal for the correction of a painful mild-to-moderate hallux valgus deformity. The clinical results appear to be comparable with those obtainable with traditional open techniques, with the additional advantages of a minimally invasive procedure, a substantially shorter operating time, and a reduced risk of complications related to surgical exposure.