The Scarf Osteotomy with Minimally Invasive Lateral Release for Treatment of 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]

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Minimally Invasive Retrocapital Osteotomy of the First Metatarsal in Hallux Valgus Deformity

Operative Orthopädie und Traumatologie ◽

10.1007/s00064-008-1231-0 ◽

2008 ◽

Vol 20 (1) ◽

pp. 89-96 ◽

Cited By ~ 30

Author(s):

Bruno Magnan ◽

Elena Samaila ◽

Gino Viola ◽

Pietro Bartolozzi

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Valgus Deformity ◽

First Metatarsal ◽

Hallux Valgus Deformity

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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.

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Scarf osteotomy as a salvage procedure for treatment of recurrent hallux valgus deformity

Foot and Ankle Surgery ◽

10.1016/j.fas.2017.07.241 ◽

2017 ◽

Vol 23 ◽

pp. 52 ◽

Cited By ~ 1

Author(s):

J. Kane ◽

R. Lewis ◽

H. Gotha ◽

D. Myer ◽

J. Brodsky

Keyword(s):

Hallux Valgus ◽

Valgus Deformity ◽

Salvage Procedure ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity

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Short Scarf Osteotomy for Hallux Valgus: Short-term and Medium-term Results

Journal of Foot and Ankle Surgery Asia Pacific ◽

10.5005/jp-journals-10040-1063 ◽

2017 ◽

Vol 4 (1) ◽

pp. 14-18

Author(s):

Rajesh Rachha ◽

Rakesh Dalal ◽

David Leonard ◽

Ajay Chourasia ◽

Saqib Javed

Keyword(s):

Hallux Valgus ◽

Operating Time ◽

Valgus Deformity ◽

Asia Pacific ◽

Medium Term ◽

Short Term ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity ◽

Valgus Angle

ABSTRACT Aim The scarf osteotomy, as popularized by Barouk, is a versatile osteotomy for the correction of moderate and severe hallux valgus deformity. However, this technique requires extensive exposure, fixation, and increased operative time, and is technically demanding. We describe and present our results of a short scarf osteotomy (SSO), which retains all the cuts of a standard scarf but requires a reduced exposure, less metalwork, less operating time, and is more economical. Materials and methods All patients who underwent SSO between January 2010 and December 2012 with minimum follow-up of 12 months were eligible for the study. Preoperative, intraoperative, and postoperative radiographs were available for radiological assessment. Results In this study, 84 patients and 94 feet were included; 90% of patients were satisfied overall, with 83% of patients recommending this surgery to a friend. The hallux valgus angle improved from a preoperative mean of 30.89° (17.4—46.8) to 12° (4—30) postoperatively (p = 0.0001). The intermetatarsal angle improved from a preoperative mean of 15.05° (10.3—21.1) to 7.14° (4—15.1) postoperatively (p = 0.0001). The average sesamoid coverage improved from grade 2.18 (1—3) preoperatively to 0.57 (0—2) postoperatively (p = 0.0001). The average American Orthopedic Foot and Ankle Score improved from 51.26 (32—88) preoperatively to 91.1 (72—100) postoperatively (p = 0.0001). Conclusion We believe that this osteotomy is a novel procedure producing good to excellent results in most cases of hallux valgus. Biologically, the decreased exposure should improve healing and reduce the risk of avascular necrosis. We strongly recommend this osteotomy for most cases of hallux valgus surgery. How to cite this article Dalal R, Rachha R, Leonard D, Chourasia A, Javed S. Short Scarf Osteotomy for Hallux Valgus: Short-term and Medium-term Results. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):14-18.

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