Impact of combining medial capsule interposition with modified scarf osteotomy for hallux valgus

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23°; increased proximal articular angle (PAA>8°), and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5°) which was statistically significant (p<0.01). The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

Download Full-text

Are Routine Postoperative X-rays Needed Following Surgery for Hallux Valgus? An Evaluation of their Use After Scarf Osteotomy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x179035 ◽

2007 ◽

Vol 89 (3) ◽

pp. 281-284 ◽

Cited By ~ 4

Author(s):

Richard J Murphy ◽

Christopher M Blundell

Keyword(s):

Hallux Valgus ◽

Teaching Hospital ◽

Retrospective Data ◽

X Rays ◽

X Ray ◽

Orthopaedic Surgeons ◽

Scarf Osteotomy ◽

Standard Management ◽

Large Teaching Hospital

INTRODUCTION Postoperative X-rays, following a scarf osteotomy, are generally carried out as routine. The aim of this study was to assess the value of performing such investigations. PATIENTS AND METHODS Retrospective data were collected regarding all scarf osteotomies performed by three consultant orthopaedic surgeons at a large teaching hospital. A review of routine postoperative X-rays was carried out. RESULTS A total of 274 scarf osteotomies were included in the study. Of these, 95% were followed by at least one routine postoperative X-ray. In total, 412 X-rays were performed of which 11% were not commented upon by a radiologist or a surgeon. Of the X-rays with comments from both specialists, only one case was reported as abnormal by both radiologist and surgeon, with no change in management made as a result of these reports. In two cases, changes to standard management were made on the basis of the routine postoperative X-rays and only one of these was implemented solely on the basis of the routine postoperative images. CONCLUSIONS The value of postoperative X-rays following a scarf osteotomy is questionable. We propose, on the basis of this study, that, unless clinically indicated, the routine use of postoperative X-rays following a scarf osteotomy should be abandoned.

Download Full-text

Outcomes of Scarf Osteotomy for Hallux Valgus Deformity

Benha Journal of Applied Sciences ◽

10.21608/bjas.2021.188863 ◽

2021 ◽

Vol 6 (3) ◽

pp. 247-252

Author(s):

G. Hosney ◽

O. Essawy ◽

M. Abou Zied ◽

E.M.E. Mostafa

Keyword(s):

Hallux Valgus ◽

Valgus Deformity ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity

Download Full-text

Interdigital vs Transarticular Lateral Release With Scarf Osteotomy

Foot & Ankle International ◽

10.1177/10711007211035374 ◽

2021 ◽

pp. 107110072110353

Author(s):

Florian Hartenbach ◽

Brigitta Höger ◽

Karl-Heinz Kristen ◽

Hans-Jörg Trnka

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Rating Scale ◽

Lateral Release ◽

Soft Tissue Release ◽

Foot And Ankle ◽

Aofas Score ◽

Level Of Evidence ◽

Scarf Osteotomy ◽

Radiographic Outcomes

Background: We compare the clinical and radiographic outcomes of the interdigital approach vs the medial transarticular approach for lateral release combined with scarf osteotomy. Methods: Seventy-seven feet with moderate to severe hallux valgus underwent scarf osteotomy and lateral soft tissue release, using an interdigital approach (n = 36) vs medial transarticular approach (n = 41). The clinical measurements (range of motion, American Orthopaedic Foot and Ankle Society [AOFAS] score) and radiographic data were evaluated preoperatively and at final follow-up (93-124 months postoperatively). Additionally, the numeric pain rating scale and Foot and Ankle Outcome score [FAOS] were assessed postoperatively. Results: The AOFAS score improved from 60 (q1 = 54, q3 = 70) to 93 (q1 = 85, q3 = 98) in the transarticular group, and from 59 (q1 = 50, q3 = 64) to 95 (q1 = 85, q3 = 100) in the interdigital group. The hallux valgus angle improved from 35.7±6.5 degrees to 15.5±7.6 degrees in the transarticular group, and from 36.0±6.8 degrees to 12.9±13.0 degrees in the interdigital group. The intermetatarsal angle improved from 16.5±2.5 degrees to 6.5±2.7 degrees within the transarticular group and from 17.2±2.5 degrees to 7.3±4.3 degrees in the interdigital group. None of the clinical or radiographic parameters showed any significant differences between the treatment groups. Conclusion: Comparison of outcomes between the interdigital approach and the transarticular approach for lateral soft-tissue release with scarf osteotomy are equally successful. The transarticular approach can thus be considered safe and effective, with the additional benefits of just one scar as opposed to 2. Level of Evidence: Level III, therapeutic.

Download Full-text

Correcting the Hallux Valgus Deformity: A Comparison Between Modified Lapidus Procedure and Scarf Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00400 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0040

Author(s):

Megan Reilly ◽

Jonathan Day ◽

Aoife MacMahon ◽

Kristin C. Caolo ◽

Bopha Chrea ◽

...

Keyword(s):

Mental Health ◽

Physical Health ◽

Physical Function ◽

Clinical Outcomes ◽

Hallux Valgus ◽

Global Mental Health ◽

Valgus Deformity ◽

Moderate Severity ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Lapidus procedure and Scarf osteotomy are indicated for treatment of mild to moderate hallux valgus. Advantages of modified Lapidus procedure include ability to address severe deformity, first tarsometatarsal arthritis, and first ray hypermobility. Advantages of Scarf osteotomy include greater correction of the distal metatarsal articular angle (DMAA) and greater fixation stability than other techniques. Both procedures have shown good radiographic and clinical outcomes; however, no prior studies have compared these outcomes between the procedures. The aim of this study was to compare clinical and radiographic outcomes between patients with hallux valgus treated with the modified Lapidus procedure or Scarf osteotomy. Methods: This retrospective cohort study included patients treated by one of seven fellowship-trained foot and ankle surgeons were identified. Inclusion criteria were age greater than 18 years, primary modified Lapidus procedure or Scarf osteotomy for hallux valgus, minimum 1-year postoperative PROMIS scores, and minimum 3-month postoperative radiographs. Revision cases were excluded. Clinical outcomes were assessed using six PROMIS domains: Pain Interference, Pain Intensity, Physical Function, Global Mental Health, Global Physical Health, and Depression. Pre- and postoperative radiographic parameters were measured on AP (HVA, IMA, DMAA, tibial sesamoid position), and lateral (talo-1st-metatarsal angle (Meary’s), Horton index, Seiberg index, sagittal IMA) x-rays. Statistical analysis utilized targeted maximum likelihood estimation controls for confounding of bunion severity by including covariates for baseline HVA and IMA. Statistics were also analyzed in a restricted cohort of mild to moderate severity bunions (HVA<40 and IMA<16; n=57 each). Complications including repeat surgeries, recurrence of deformity, and malunion/nonunion were recorded. Results: 136 patients (73 Lapidus, 63 Scarf) with average 17.8 month follow-up constituted our study. Both groups demonstrated significant improvement in Global Physical Health, Global Mental Health, and Physical Function, with patients in the Lapidus group showing a significantly greater improvement of 3.6 points (p=0.01) compared to Scarf. After controlling for bunion severity, the probability of having normal postoperative IMA (<10 ) was 17% lower (p<0.001) with Scarf compared to Lapidus. This finding was consistent in the restricted cohort of mild to moderate severity bunions. Lapidus group demonstrated significantly greater correction in Meary’s angle, Seiberg index, and sagittal IMA. Complications in the Lapidus group included one nonunion, three symptomatic implants, two hallux varus. The Scarf group had one reoperative cheilectomy and one second metatarsal stress fracture. Conclusion: This is the first study to compare both radiographic and patient-reported outcomes between Lapidus procedure and Scarf osteotomy for correction of hallux valgus deformity. While both procedures yielded improvements in outcomes, results suggest that the probability of having a normal postoperative IMA is greater with Lapidus procedure, even when adjusted for severity of deformity. In addition, greater correction reflected in sagittal measurements may further support the role of rotational correction in the Lapidus procedure. [Table: see text]

Download Full-text

Shortening Scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome

Foot and Ankle Surgery ◽

10.1016/j.fas.2016.05.242 ◽

2016 ◽

Vol 22 (2) ◽

pp. 93-94

Author(s):

P. Karpe ◽

A. Chauhan ◽

M. Killen ◽

R. Limaye

Keyword(s):

Hallux Valgus ◽

Scarf Osteotomy ◽

Severe Hallux Valgus

Download Full-text

Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

Foot & Ankle International ◽

10.1177/1071100716666566 ◽

2016 ◽

Vol 38 (1) ◽

pp. 20-26 ◽

Cited By ~ 5

Author(s):

Jun Young Choi ◽

Yu Min Suh ◽

Ji Woong Yeom ◽

Jin Soo Suh

Keyword(s):

Hallux Valgus ◽

Deformity Correction ◽

Metatarsal Head ◽

Valgus Deformity ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

First Metatarsal ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity ◽

Second Metatarsal

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Results: Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Conclusions: Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level of Evidence: Level III, retrospective comparative series.

Download Full-text

Effect of Akin Osteotomy on Hallux Valgus Correction After Scarf Osteotomy With Hallux Valgus Interphalangeus

Foot & Ankle International ◽

10.1177/1071100719855043 ◽

2019 ◽

Vol 40 (10) ◽

pp. 1182-1188 ◽

Cited By ~ 1

Author(s):

Gerhard Kaufmann ◽

Philipp Hofer ◽

Matthias Braito ◽

Reto Bale ◽

David Putzer ◽

...

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Level Of Evidence ◽

Scarf Osteotomy ◽

Loss Of Correction ◽

Valgus Angle ◽

Akin Osteotomy ◽

Group A ◽

Joint Congruity ◽

Initial Correction

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.

Download Full-text