Improvement of Valgus Deviation of the Lesser Toes of Moderate to Severe Hallux Valgus After Proximal Chevron Metatarsal Osteotomy and Akin Osteotomy

Category: Lesser Toes Introduction/Purpose: The valgus deviation of lesser toes is often found in the hallux valgus patients. It has been known that valgus deviation of lesser toes remain unchanged even after correction of hallux valgus. The purpose of this study was to determine whether valgus deviation of lesser toes can be corrected after proximal chevron metatarsal osteotomy (PCMO) and Akin osteotomy for the hallux valgus patients, and to evaluate the factors affecting the degree of correction. Methods: The study is based on 116 feet (89 patients) of moderate to severe hallux valgus that underwent proximal chevron metatarsal osteotomy with Akin ostetomy. Hallux valgus angle (HVA), inter-metatarsal angle (IMA), valgus angle of 2nd, 3 rd, 4th metatarso-phalangeal joint were assessed preoperatively and postoperative 6 month, 1 year and yearly. VAS pain cores, American Orthopedic Foot and Ankle Society metatarsophalangeal-interphalangeal (AOFAS MTP-IP) scale and patient satisfaction were evaluated preoperatively and at subsequent follow-up. Results: The average follow-up was 30.6 months (range,12-99). The mean HVA and IMA reduced from 34.4° to 8.7° and 15.9° to 5.3° respectively at the final follow-up. Patients with more severe HVA showed higher degree of valgus deviation of lesser toes than those with lesser HVA. The valgus angle of 2nd,3 rd,4th MTP joints reduced from 8.9°, 6.7°, 2.4° preoperatively to 5.6°, 4.9°, 1.3° respectively at the final follow-up (p<0.05). The more HVA corrected, the more valgus deviation of lesser toe was found corrected. There was no significant difference in the degree of lesser toe correction angle according to follow up period after postoperative 1 year. The mean VAS and AOFAS scores significantly improved from 6.0, 60.9 to 1.2, 92.0 at the final follow-up, respectively (P<0.05). Conclusion: Unlike the previous reports, the current study showed significant reduction of the valgus angle of 2nd, 3 rd, 4th MTP joints after PCMO and Akin osteotomy for the moderate to severe HV without additional corrective lesser toe surgery.

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Effectiveness of Percutaneous Proximal Closing Wedge Osteotomy With Akin Osteotomy to Correct Severe Hallux Valgus Determined by Radiographic Parameters

Foot & Ankle Specialist ◽

10.1177/1938640016668031 ◽

2016 ◽

Vol 10 (2) ◽

pp. 170-179 ◽

Cited By ~ 7

Author(s):

Toshinori Kurashige ◽

Seiichi Suzuki

Keyword(s):

Hallux Valgus ◽

Wedge Osteotomy ◽

Metatarsal Osteotomy ◽

Closing Wedge Osteotomy ◽

First Metatarsal ◽

Closing Wedge ◽

Valgus Angle ◽

Akin Osteotomy ◽

Severe Hallux Valgus

Some authors reported the results from percutaneous distal metatarsal osteotomy for hallux valgus recently. On the other hand, there are few reports of percutaneous proximal metatarsal osteotomy. The purpose of the present study was to evaluate the radiographic results of percutaneous proximal closing wedge osteotomy with Akin osteotomy for correction of severe hallux valgus and increasing longitudinal arch height. Consecutive 17 feet (mean age = 70.8 years) were investigated. The mean follow-up was 22 months. Excision of medial eminence, distal soft tissue release, and Akin osteotomy were all performed percutaneously and concurrently. Weight-bearing anteroposterior and lateral radiographs of the feet were acquired preoperatively and at final follow-up. On the anteroposterior radiographs, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening were measured. On the lateral radiographs, talometatarsal angle, calcaneal pitch angle, and first metatarsal dorsiflexion were measured. The average improvements in hallux valgus angle and intermetatarsal angle were 27.6° and 9.9°, respectively. The average first metatarsal shortening was 2.7 mm. The first metatarsal dorsiflexion improved by 2.2°; however, other parameters did not improve significantly. In conclusion, percutaneous proximal closing wedge osteotomy with Akin osteotomy corrects severe hallux valgus; however, the procedure does not increase the medial longitudinal arch. Levels of Evidence: Therapeutic, Level IV: Case series

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Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000231 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Hwa Jun Kang ◽

Hong-Geun Jung ◽

Jong-Soo Lee ◽

Sungwook Kim ◽

Mao Yuan Sun

Keyword(s):

Hallux Valgus ◽

Screw Fixation ◽

Fixation Method ◽

Kirschner Wires ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

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Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy

Foot & Ankle International ◽

10.1177/1071100720937645 ◽

2020 ◽

Vol 41 (10) ◽

pp. 1212-1218

Author(s):

Gavin John Heyes ◽

Amir R. Vosoughi ◽

Lizzy Weigelt ◽

Lyndon Mason ◽

Andrew Molloy

Keyword(s):

Hallux Valgus ◽

P Value ◽

Level Of Evidence ◽

Pes Planus ◽

First Metatarsal ◽

Scarf Osteotomy ◽

Metatarsal Angle ◽

Valgus Angle ◽

Akin Osteotomy

Background: Hallux valgus recurrence is an unsatisfactory complication, with many causes postulated. This study investigated the effect of pes planus on recurrence after scarf osteotomy. Methods: A total of 183 feet were retrospectively reviewed. All patients were treated with a scarf osteotomy and if required Akin osteotomy. We measured preoperative lateral talus first metatarsal angle (T1MA) to study pes planus; an angle of under −4 degrees was considered pes planus. We measured pre and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and sesamoid location. In total 164 feet were suitable for inclusion, with follow-up of at least 6 months (10 males and 154 females, mean age: 52 years). Results: Recurrence frequency (HVA greater than 15 degrees) was 27 feet (16%). Hallux valgus recurrence was not influenced by gender ( P value = .66) or preoperative IMA ( P value = .48). Preoperative HVA greater than 35 degrees was associated with increased frequency of recurrence ( P value = .004). Those with T1MA less than −10 degrees demonstrated progression in HVA and deterioration in sesamoid location up to 6 months postoperatively ( P value = .038). HVA did not progress beyond 6 months. The prevalence of recurrent hallux valgus with normal T1MA was 1%, in T1MA −4 to −10 degrees it was 29% and in T1MA less than −10 degrees it was 47% ( P value <.001). Breaks in T1MA less than −4 degrees were found at the naviculocuneiform joint in 68% of feet in this series. Conclusion: The prevalence of hallux valgus recurrence correlated with the severity of pes planus. Level of Evidence: Level III, retrospective cohort study.

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Distal Linear Metatarsal Osteotomy Combined with Akin Osteotomy for Hallux Valgus with Hallux Valgus Interphalangeus

The Open Orthopaedics Journal ◽

10.2174/1874325001913010034 ◽

2019 ◽

Vol 13 (1) ◽

pp. 34-41

Author(s):

Kazuki Kanazawa ◽

Ichiro Yoshimura ◽

Tomonobu Hagio ◽

Takuaki Yamamoto

Keyword(s):

Hallux Valgus ◽

Metatarsal Head ◽

Clinical Results ◽

Osteotomy Site ◽

Metatarsal Osteotomy ◽

Intermetatarsal Angle ◽

Hallux Valgus Interphalangeus ◽

Valgus Angle ◽

Akin Osteotomy

Background: Minimally invasive distal linear metatarsal osteotomy is commonly performed to correct mild-to-moderate hallux valgus. The technique is easy to perform, fast, and has a low complication rate with satisfactory clinical results. However, it has so far not been applied to hallux valgus with concomitant hallux valgus interphalangeus deformity. Objective: We aimed to investigate the short-term clinical results of distal linear metatarsal osteotomy combined with Akin osteotomy in hallux valgus with concomitant hallux valgus interphalangeus deformity. Methods: We retrospectively reviewed 10 patients (10 feet) who underwent surgery for hallux valgus with hallux valgus interphalangeus between 2012 and 2016. Akin osteotomy was performed and fixated with a screw/K-wire, followed by distal linear metatarsal osteotomy and K-wire fixation. Clinical evaluations pre- and postoperatively used the Japan Society for Surgery of the Foot (JSSF) scale and the Visual Analog Scale (VAS). Radiography pre-and postoperatively assessed the hallux valgus, hallux valgus interphalangeus, and the intermetatarsal angle. Results: The mean follow-up period was 20.2 months. Both the JSSF and VAS score improved significantly, from 64.5 to 90.0 and from 5.5 to 1.1, respectively. In all patients, bone healing was complete within four months with no osteonecrosis of the metatarsal head or malunion at the osteotomy site. The hallux valgus angle improved from 31.5° to 7.7°, the hallux valgus interphalangeus angle from 17.2° to 5.8°, and the intermetatarsal angle from 11.7° to 5.5°. Conclusion: Distal linear metatarsal osteotomy combined with Akin osteotomy safely and effectively corrects mild-to-moderate hallux valgus with hallux valgus interphalangeus deformity.

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Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00130 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0013

Author(s):

Sofia Carlucci ◽

Nelly Carrasco ◽

Maria Santini-Araujo ◽

Ana Parise ◽

Leonardo Conti ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Deformity Correction ◽

Hallux Valgus Angle ◽

Chevron Osteotomy ◽

Metatarsal Angle ◽

Valgus Angle ◽

Akin Osteotomy ◽

American Orthopaedic

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The use of minimally invasive techniques for hallux valgus may provide complete deformity correction with minor soft tissue damage, which reduces morbidity and shortens recovery. In this way, some open osteotomies were adapted to percutaneous approaches, with good outcomes reported. The minimally invasive chevron-Akin (MICA) described by Vernois and Redfern in 2011, combines benefits of percutaneous approaches with a stable internal fixation. Since 2015 we have adapted this technique, by adding a percutaneous adductor tenotomy to dispense with the Akin osteotomy. The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a minimally invasive chevron osteotomy and a percutaneous adductor tendon release. Methods: This was a prospective cohort study. A total of 38 feet with moderate hallux valgus underwent the procedure and were followed up for a minimum 12 months (SD 1.10). The median age was 58 years (IQR 52 - 65), 36 women and 2 men. Radiological parameters were compared at preoperatory and at the last follow-up and included: Hallux Valgus Angle (HVA), Inter- Metatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and first metatarsal shortening. Time to consolidation was also assessed. For clinical evaluation the American Orthopaedic Foot & Ankle Society score (AOFAS) was evaluated. Complications during the follow up were reported. Patients in which another procedure in the hallux was performed, with previous surgeries or not completed 1 year follow-up were excluded. Results: Radiologic postoperative parameters demonstrated to achieved correction. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and distal metatarsal articular angle. Shortening of the first metatarsus was a mean 7.02 mm (IQR 1.24 - 10,27). The mean AOFAS score increased from 58.23 (SD 9.02) pre-operatively to 97.15 (SD 4.72) post-operatively (p< 0.001). Complications reported were 2 superficial infections, 1 broken screw, 1 screw extraction. Five patients referred metatarsalgia after surgery and 1 presented a fourth metatarsal stress fracture. Only one patient presented lost of correction in the first postoperative week and needed a second surgery. Conclusion: Our series of hallux valgus correction with a minimally invasive chevron osteotomy combined with the adductor tendon release shows good clinical and radiological outcomes, and results are comparable to series with the additional Akin osteotomy. Comparative studies are needed for major evidence.

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Effect of Metatarsus Adductus on Hallux Valgus Treated With Proximal Reverse Chevron Metatarsal Osteotomy

Foot & Ankle International ◽

10.1177/1071100721990363 ◽

2021 ◽

pp. 107110072199036

Author(s):

Seung-Myung Choi ◽

Jong-Soo Lee ◽

Jung-Won Lim ◽

Je-Min Im ◽

Duk-Hwan Kho ◽

...

Keyword(s):

Patient Satisfaction ◽

Hallux Valgus ◽

Recurrence Rate ◽

Metatarsal Osteotomy ◽

Aofas Score ◽

Level Of Evidence ◽

Significant Difference ◽

Metatarsus Adductus ◽

The Mean

Background: This study aimed to compare clinical and radiographic outcomes and recurrence rates after reverse proximal chevron metatarsal osteotomy (PCMO) for patients with hallux valgus (HV) with or without metatarsus adductus (MA). We hypothesized that patients with MA would have poorer outcomes and a higher radiographic recurrence rate than those without MA. Methods: This retrospective single-surgeon series comprised 144 patients (173 feet) with moderate to severe HV, treated with PCMO and Akin osteotomy without lesser metatarsal procedures, who were grouped according to the presence (MA group) or absence of MA (non-MA group). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Radiographic assessments included metatarsus adductus angle (MAA), HV angle (HVA), and intermetatarsal angle (IMA). Results: The prevalence of the MA was 24.2%. The mean MAA was 23.1 ± 3.3 degrees in the MA group. There were no differences in the mean AOFAS score and pain VAS score at the final follow-up between the 2 groups (all P > .05). The patient satisfaction rate was 73.8% in the MA group vs 90.1% in the non-MA group ( P = .017). The mean postoperative HVA and IMA significantly improved at the final follow-up in both groups, respectively (all P < .001). Preoperative and postoperative HVA were larger in the MA group vs non-MA group. However, no significant difference was found in the improvement of HVA and IMA after surgery between the 2 groups (all P > .05). The recurrence rate was 28.6% in the MA group and 6.1% in the non-MA group ( P < .001). Conclusion: HV patients associated with the MA had a higher degree of preoperative HV, lower correction of the HVA, higher radiographic recurrence rate, and poorer patient satisfaction than those without MA post-PCMO without lesser metatarsal procedures. Therefore, a more extensive HV correction procedure or the addition of a lesser metatarsal realignment procedure may need to be considered. Level of Evidence: Level III, retrospective comparative series.

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Proximal Oblique Crescentic Osteotomy in Hallux Valgus

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-94-1-43 ◽

2004 ◽

Vol 94 (1) ◽

pp. 43-46 ◽

Cited By ~ 11

Author(s):

Ozcan Pehlivan ◽

Ibrahim Akmaz ◽

Can Solakoglu ◽

Ahmet Kiral ◽

Haluk Kaplan

Keyword(s):

Hallux Valgus ◽

Osteotomy Site ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Valgus Angle ◽

Before And After ◽

The Mean ◽

American Orthopaedic ◽

Severe Hallux Valgus

Twenty-six patients with moderate-to-severe hallux valgus deformities were evaluated before and after treatment. All of the patients had incongruent great toe joints. The patients underwent modified proximal crescentic osteotomy, which was termed proximal oblique crescentic osteotomy. The results were evaluated at an average follow-up time of 55 weeks. Objective criteria were hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal, and angulation at the osteotomy site. Clinical evaluation was made according to the rating system of the American Orthopaedic Foot and Ankle Society. The mean correction of the hallux valgus and intermetatarsal angles was 22.1° and 9.9°, respectively. Short-term results indicate that proximal oblique crescentic osteotomy is effective in the treatment of hallux valgus; its advantages over other procedures include its technical ease and low rate of complications. (J Am Podiatr Med Assoc 94(1): 43-46, 2004)

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Comparison of Radiographic and Clinical Results After Extended Distal Chevron Osteotomy With Distal Soft Tissue Release With Moderate Versus Severe Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100718807893 ◽

2018 ◽

Vol 40 (3) ◽

pp. 297-306 ◽

Cited By ~ 2

Author(s):

Jae Hwang Song ◽

Chan Kang ◽

Deuk Soo Hwang ◽

Gi Soo Lee ◽

Sang Bum Lee

Keyword(s):

Hallux Valgus ◽

Clinical Results ◽

Soft Tissue Release ◽

Hallux Valgus Angle ◽

Intermetatarsal Angle ◽

Chevron Osteotomy ◽

Valgus Angle ◽

The Mean ◽

Severe Hallux Valgus

Background: We compared the radiographic and clinical outcomes of moderate and severe hallux valgus treated by extended distal chevron osteotomy (EDCO) and distal soft tissue release (DSTR). Methods: We performed a retrospective analysis comparing the utility of EDCO for the treatment of moderate (36 patients, 46 feet) and severe (36 patients, 42 feet) hallux valgus. The radiologic outcomes were evaluated based on the preoperative and 3-year follow-up x-rays. The clinical results were investigated based on the 3-year follow-up Manchester-Oxford Foot Questionnaire (MOXFQ), patient satisfaction, and postoperative complications. Results: The mean postoperative intermetatarsal angle, hallux valgus angle, tibial sesamoid position, and relative metatarsal bone length were significantly different compared with the preoperative values for both the moderate and severe groups ( P < .001). At 3-year follow-up, intergroup differences were observed in the mean postoperative intermetatarsal angle ( P = .001), hallux valgus angle ( P = .003), and tibial sesamoid position ( P = .013); however, mean radiographic results were within the normal range for both groups. There were no intergroup differences for either the first metatarsal bone length ( P = .172) or shortening ( P = .621). No significant difference in MOXFQ ( P = .525) was evident between the groups at 3-year follow-up. In satisfaction analysis, 82.6% of the moderate group reported good to excellent results, as did 81.0% of the severe group ( P = .815). A total of 7 complications were reported in each group ( P = 1.000). Conclusion: The present study showed that midterm mean radiographic results of both moderate and severe hallux valgus treated by EDCO with DSTR were favorable, and those values were within the normal range. Clinical outcomes were comparable between the 2 groups, including overall efficacy. Based on these results, we recommend EDCO with DSTR as an efficient and reliable operative option for both moderate and severe hallux valgus. Level of Evidence: Level III, retrospective comparative study.

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Mobility Changes in the First TMT Joint after Proximal First Metatarsal Osteotomy for Hallux Valgus Evaluated by Weightbearing CT and a 3D Analysis System

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000244 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Tadashi Kimura ◽

Makoto Kubota ◽

Hidekazu Hattori ◽

Kazuhiko Minagawa ◽

Naoki Suzuki ◽

...

Keyword(s):

Hallux Valgus ◽

Three Dimensional ◽

Metatarsal Osteotomy ◽

First Metatarsal ◽

Valgus Angle ◽

Medial Cuneiform ◽

First Ray ◽

The Mean ◽

Weightbearing Ct

Category: Bunion Introduction/Purpose: In a previous study, we found that feet with hallux valgus show significantly greater three-dimensional mobility than normal feet in all joints of the first ray. Displacement was particularly pronounced in the first TMT joints, indicating that this is the primary cause of first ray hypermobility. We developed a plate used specifically for proximal first metatarsal osteotomy to perform three-dimensional correction of hallux valgus and associated deformities. In this study, we evaluated changes in mobility of the first TMT joints after surgery in 3D using weightbearing CT. Methods: The subjects were 5 feet of 5 female patients with hallux valgus (mean age 56 years, mean hallux valgus angle 38°). We performed non-weightbearing and weightbearing (using a load equivalent to body weight) CT scans before surgery using an original loading device (Fig a). We reconstructed 3D models from captured images by segmentation and defined axial coordinate system (Fig b). Next, we measured the three-dimensional displacement of the first metatarsal bone relative to the medial cuneiform bone under weightbearing conditions. At 1 to 1.5 years after proximal metatarsal osteotomy for all patients, we performed a follow-up CT scans using the same method and compared preoperative and postoperative displacement. Student’s t- test was performed to statistically compare data and statistical significance was set at p < 0.05. Results: Postoperatively (when performing a follow up CT), the mean hallux valgus angle improved from 38° to 10° and the mean first-second metatarsal angle improved from 23° to 7°. The mean score on the Japanese Society for Surgery of the Foot hallux scale improved from 62 points to 97 points. Displacement of the first metatarsal bone relative to the medial cuneiform bone between non-weightbearing and weightbearing conditions decreased significantly in all directions, from 4.2° ± 1.8° to 1.6° ± 1.1° of dorsiflexion (p = 0.02), 4.9° ± 1.8° to 0.7° ± 0.9° of inversion (p = 0.001), and 4.4° ± 1.9° to 1.7° ± 0.8° of adduction (p = 0.01). Conclusion: Displacement of the first TMT joints under weightbearing conditions decreased after our surgery. This indicates that the surgery corrected hallux valgus and associated pes planus and produced favorable functional outcomes by improving the shape of the foot and hypermobility of the first ray through correction of the orientation and tension of surrounding tendons and ligaments and the plantar aponeurosis. In the future, we plan to further examine the pathology and treatment of hallux valgus with a focus on postoperative changes in soft tissue orientation.

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Outcomes after Rotation Scarf with Akin Osteotomy for Severe Hallux Valgus

10.21203/rs.3.rs-733306/v1 ◽

2021 ◽

Author(s):

Wenyong Xie ◽

Hao Lu ◽

Guicheng Li ◽

Yusong Yuan ◽

Yijun Liu ◽

...

Keyword(s):

Hallux Valgus ◽

Valgus Deformity ◽

Optimal Choice ◽

Foot Deformities ◽

Hallux Valgus Deformity ◽

Valgus Angle ◽

Akin Osteotomy ◽

Severe Hallux Valgus

Abstract Background: Hallux valgus is one of the most common foot deformities. Surgical treatment is the optimal choice for moderate to severe hallux valgus deformity. Rotation scarf with Akin osteotomy has become increasingly popular. The purpose of our study is to evaluate the long-term outcomes of rotation scarf with Akin osteotomy on severe hallux valgus. Methods: We conducted a retrospective study of patients with hallux valgus who underwent surgery using rotation scarf with Akin osteotomy in our hospital between June 2014 and January 2020. Anteroposterior and lateral weightbearing X-ray were performed before and after the operation. The parameters evaluated include (1) the hallux valgus angle (HVA), (2) intermetatarsal angle (IMA), (3) distal metatarsal articular angle (DMAA) and (4) tibial sesamoid position (TSP). A visual analog scale (VAS) was used to evaluate the pain level before and at the last follow-up after the operation. American Orthopaedic Foot & Ankle Society (AOFAS) Forefoot Score were assessed before and at the last follow-up after the operation. Patient satisfaction assessment was also conducted at the time. Results: A total of 42 patients with 50 feet met our inclusion criteria. Average age at the time of surgery was 61 ± 9 years. Follow-up data were obtained in all 42 patients. The average follow-up time was 47.4 ± 20 months. All radiological parameteres including HVA, IMA, DMAA and TSP had statistically significant improvement (p < 0.001). The VAS score and AOFAS score was also statistically significant before operation and at the last follow-up after the operation (p < 0.001). There are 41 (82%) feet in patients were very satisfied or satisfied. Conclusion: Rotation scarf with Akin osteotomy is demonstrated to be safe, effective, and feasible for correcting severe hallux valgus. It can obtain good long-term correction with a low incidence of recurrence and metatarsalgia. Postoperative satisfaction and functional recovery of patients are significantly improved.

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