Comparative study of scarf and extended chevron osteotomies for correction of hallux valgus (original) (raw)
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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.
Archives of bone and joint surgery, 2014
Hallux valgus deformity is a common chronic problem with a reported prevalence of 28.4% and its chief complaint is pain. Thus far, different surgical procedures with their proposed indications have been introduced. This study compared three current procedures, namely the chevron and scarf osteotomies and the McBride procedure. This retrospective cohort was conducted at the Ahvaz University of Medical Sciences on 44 patients with moderate hallux valgus deformity from 2010 and 2013. All of the patients underwent one of the three procedures (chevron, scarf or McBride). Preoperative and follow up radiographies were evaluated in terms of hallux valgus and intermetatarsal angle correction. The Foot and Ankle Disability Index was filled out to assess the functional outcome and the Visual Analogue Scale was used to evaluate pain. Also, satisfaction, aesthetics and the rate of recurrence was evaluated. Hallux valgus angle and intermetatarsal angle correction were significantly higher in scar...
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.
Chevron Versus Mitchell Osteotomy in Hallux Valgus Surgery: A Comparative Study
The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 2014
Good clinical results have been reported for chevron and Mitchell osteotomies in mild hallux valgus (HV). The primary aim of the present study was to compare first metatarsal shortening after chevron and Mitchell osteotomies in HV. The secondary outcome measures were the degree of valgus correction, metatarsalgia, and patient satisfaction. A total of 84 patients were included in the present study and were treated from 2005 to 2007; 42 patients were in each group. The outcome measurements-first metatarsal length, HV angle, 1-2 intermetatarsal angle, satisfaction, and metatarsalgia-were taken preoperatively and at follow-up. The Mitchell osteotomy resulted in a significantly larger decrease in the first metatarsal length. No significant difference in transfer metatarsalgia was found. Approximately 30% of patients were mildly or not satisfied after HV surgery. Mitchell osteotomy leads to a larger decrease in the first metatarsal length. Patients with metatarsalgia performed poorly, and...
Acta Orthopaedica et Traumatologica Turcica, 2018
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 ¼ 0,327) and IMA (r ¼ 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.
International Journal of Health Sciences and Research, 2015
Introduction: Hallux valgus is one of the commonest forefoot deformities; with an estimated prevalence of 23% to 35%.Despite the large number of correction procedures, controversy still remains regarding the best procedure for severe deformity correction. Purpose: The purpose of this study was to analyze the clinical and radiological outcomes of ChevronAkin double osteotomy in moderate-to-severe hallux valgus deformity. We evaluated prospectively 16 patients during August’12 to December’14 who underwent Chevron-Akin double osteotomy for correction of moderate to severe hallux valgus deformity. Preoperative and postoperative AOFAS scores, patient satisfaction, and radiographic data (HVA, IMA and DMAA) were used to evaluate the effectiveness of the procedure. Complications were recorded. Mean follow up was of 22 months (range 18–27 months). Results: The average preoperative AOFAS score of 52 (range, 34–76) improved (p<0.01) to 90.3 (range, 58–100), the averaged HVA of 37 0 (range, ...
Scarf Osteotomy for the Correction of Hallux Valgus: Midterm Clinical Outcome
The Journal of Foot and Ankle Surgery, 2008
We prospectively reviewed 22 patients (31 feet) who underwent a scarf osteotomy between January 2001 and March 2002. There were 20 females and 2 males. Ages ranged from 35 to 77 years (mean ϭ 57 years). American Orthopedic Foot and Ankle Society (AOFAS) scores improved from a preoperative mean of 47.94 Ϯ 13.57 and increased significantly to 96.10 Ϯ 6.15 (P Ͻ .01) after 12 months. The hallux valgus angle improved in all patients from a preop mean of 31.4 Ϯ 8.0 degrees to 11.0 Ϯ 10.8 degrees at 12 months. The intermetatarsal angle improved from 13.0 Ϯ 4.2 degrees to 6.1 Ϯ 3.2 degrees. All of these changes were significant. Bony union was achieved in all patients. There were no significant changes in peak pressure, pressure/time, or force/time pedobarography noted after 12 months. Significant improvement in pain scores from preoperative mean of 21.29 Ϯ 11.0 to 32.90 Ϯ 9.57 at 5 years (P Ͻ .01) was noted and 90.9% of patients remained satisfied with the operation and would recommend the procedure. There were 2 complications. One patient experienced a traumatic neuroma and another avascular necrosis of the first metatarsal head. The scarf osteotomy is a safe and effective procedure with reproducible and excellent medium-term results.
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.
The Journal of Foot and Ankle Surgery, 2008
In our retrospective study, we report the objective results of the Mau osteotomy in the treatment of hallux valgus. We reviewed the results of 24 cases of moderate to severe hallux valgus deformities corrected with the Mau osteotomy of the first metatarsal combined with a distal soft-tissue procedure. Follow-up was possible in 24 cases. Preoperatively the mean hallux valgus and first intermetatarsal angles were 31.3 degrees and 16.6 degrees respectively, and were corrected postoperatively to an average of 13.00 degrees+/-7.15 degrees and 9.80 degrees+/-2.43 degrees respectively (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). In the sagittal plane, the first metatarsal was shortened by an average of 2.00 mm. Two (8.3%) cases had dorsal elevation of the osteotomy fragment. Complications included 3 recurrences of the deformity, 1 frank nonunion, 8 dorsal cortical nonunions, 5 cases of undercorrection, and 1 case of broken hardware that was present in the nonunion that went on to revision. There were no superficial or deep infections, and no cases of transfer metatarsalgia were noted. In this series, the use of an oblique first metatarsal osteotomy with a dorsal shelf resulted in reliable and powerful correction of the first intermetatarsal angle in patients with moderate to severe hallux valgus. Particular attention should be paid to severe IM angles and the possibility of undercorrections. Despite ambulation postoperatively, the Mau osteotomy minimized dorsal malunion and the incidence of transfer metatarsalgia. 4.