Scarf Osteotomy for Hallux Valgus Deformity

2010 ◽  
Vol 100 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Jeroen J. K. De Vil ◽  
Peter Van Seymortier ◽  
Willem Bongaerts ◽  
Pieter-Jan De Roo ◽  
Barbara Boone ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Prospective Studies ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Severe Hallux Valgus

Background: Scarf midshaft metatarsal osteotomy has become increasingly popular as a treatment option for moderate-to-severe hallux valgus deformities because of its great versatility. Numerous studies on Scarf osteotomy have been published. However, no prospective studies were available until 2002. Since then, only short-term follow-up prospective studies have been published. We present the results of a prospective study of 21 patients treated by Scarf osteotomy for hallux valgus with follow-up of 8 years. Methods: Between August 1, 1999, and October 31, 1999, 23 patients (23 feet) with moderate-to-severe hallux valgus deformity were included. Clinical (American Orthopaedic Foot and Ankle Society score) and radiologic (hallux valgus angle, first intermetatarsal angle, and sesamoid position) evaluations were performed preoperatively and 1 and 8 years postoperatively. Results: Clinical evaluation showed a significant improvement in the mean forefoot score from 47 to 83 (of a possible 100) at 1 year (P < .001). Radiographic evaluation showed significant improvement in the hallux valgus angle (mean improvement, 19°; P < .001) and in the intermetatarsal angle (mean improvement, 6°; P < .001). These clinical and radiographic results were maintained at the final evaluation 8 years postoperatively. Conclusions: Scarf osteotomy tends to provide predictable and sustainable correction of moderate-to-severe hallux valgus deformities. (J Am Podiatr Med Assoc 100(1): 35–40, 2010)

scholarly journals Natural Progression of Radiographic Indices in Juvenile Hallux Valgus Deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0031
Author(s):  
Seung Yeol Lee ◽  
Soon-Sun Kwon ◽  
Moon Seok Park ◽  
Kyoung Min Lee
Keyword(s):  
Hallux Valgus ◽  
Older Patients ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Younger Patients ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Metatarsus Adductus

Category: Bunion Introduction/Purpose: There is a lack of quantitative studies on the progression of juvenile hallux valgus deformity. Therefore, we performed this study to estimate an annual change of radiographic indices for juvenile hallux valgus. Methods: We reviewed medical records of consecutive patients under the age of 15 with juvenile hallux valgus who underwent weight-bearing foot radiographs more than twice, and were followed over a period of one year or more. A total of 133 feet from 69 patients were included. Hallux valgus angle, hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-1st metatarsal angle, anteroposterior talo-2nd metatarsal angle, and lateral talo-1st metatarsal angle were measured and were used as a study criteria. The progression rate of hallux valgus angle was adjusted by multiple factors including the use of a linear mixed model with gender and radiographic measurements as the fixed effects and laterality and each subject as the random effect. Results: Our results demonstrate that the value of hallux valgus angle on the radiographs progressed as the patients grew older. The hallux valgus angle increased by 0.8° per year (p<0.001)(Figure). The distal metatarsal articular angle also increased by 0.8 per year (p=0.003). Conversely, hallux interphalangeal angle decreased by 0.2° per year (p=0.019). Progression of the intermetatarsal angle and metatarsus adductus angle with aging were not statistically significant. There was a difference in progression of radiographic indices between older patients (≥10 years) and younger patients (<10 years). The hallux valgus angle increased by 1.5° per year (p<0.001) in younger patients, progression of the hallux valgus angle in older patients was not statistically significant (p=0.869) as children grew up. Conclusion: These results suggest that the hallux valgus angle increased in patients with juvenile hallux valgus under 10 years old, unlike the patients aged 10 or older. We believed that our results can help surgeons to determine a treatment strategy that uses the growth potential to achieve correction of deformity such as lateral hemiepiphyseodesis of the 1st metatarsal to patients with juvenile hallux valgus.

Biplanar Chevron Osteotomy

2002 ◽  
Vol 23 (9) ◽  
pp. 792-798 ◽  
Author(s):  
Caio Nery ◽  
Rui Barroco ◽  
Cibele Réssio
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Average Score ◽  
Intermetatarsal Angle ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Radiological Data ◽  
End Of Treatment

Results of biplanar chevron osteotomy performed on patients with mild-to-moderate hallux valgus deformity with an increased distal metatarsal articular angle (DMAA) are shown. The study included clinical data of 32 patients (54 feet) who had completed a 2-year follow-up, and radiological data of these 32 and other 29 patients (50 feet) for a total of 61 patients (104 feet, 53 right and 51 left). There were 59 females and two males with ages varying from 11 to 66 years. According to the AOFAS Hallux Rating, the preoperative average score (50) improved to 90 (average score after the surgery). The hallux valgus angle was improved from an average of 25° to 14°, the first intermetatarsal angle from 12° to 8° and the DMAA from 15° to 5°. At the end of treatment, 94% of patients were classified as having grade 0 or I sesamoid lateral sub-luxation. Given improvement in angles and 90% of patients satisfied with an average AOFAS postoperative score of 90, the technique seems indicated for treatment of symptomatic hallux valgus deformity with increased DMAA.

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

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.

scholarly journals Is Generalized Ligamentous Laxity a Prognostic Factor for Recurred Hallux Valgus Deformity?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Byung-Ki Cho ◽  
Seung-myung Choi
Keyword(s):  
Hallux Valgus ◽  
Postoperative Recurrence ◽  
Valgus Deformity ◽  
Foot And Ankle ◽  
Hallux Valgus Angle ◽  
Ligamentous Laxity ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Category: Bunion Introduction/Purpose: It is still unclear whether generalized ligamentous laxity is a risk factor for recurred hallux valgus deformity. This study was performed to evaluate the intermediate-term clinical outcomes after proximal chevron osteotomy for hallux valgus in patients with generalized ligamentous laxity, and to determine the effect on postoperative recurrence of deformity. Methods: A total of 198 feet from 169 female patients were treated with a proximal chevron osteotomy for hallux valgus with a mean follow-up of 46.3 months. When generalized ligamentous laxity was defined as Beighton score ≥ 5 points, there were 18 patients (10.7%) in laxity group and 151 patients (89.3%) in non-laxity group. Clinical evaluation consisted of the American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Ability Measure (FAAM), and radiographic measurement of hallux alignment. Risk factors associated with postoperative recurrence were evaluated using univariate analysis. Results: Recurrence rates were 21.7% in the laxity group and 17.1% in non-laxity group (p = 0.218), when defined as hallux valgus angle ≥ 20°. No significant differences of measurement at final follow-up were found between the 2 groups in terms of AOFAS score, FAAM, recurrence rate, hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). Preoperative HVA and IMA were found to be predictive factors of recurrence (OR = 6.3, 4.2; P = .001, .018, respectively). Conclusion: There were no statistical differences in the clinical and radiographic outcomes between hallux valgus with and without generalized ligamentous laxity. Generalized ligamentous laxity demonstrated no definitive effects on postoperative recurrence of hallux valgus deformity.

scholarly journals Comparison of the clinical outcomes of Scarf and Chevron Osteotomy for Hallux Valgus Deformity: a meta-analysis of randomized controlled trial

2019 ◽  
Author(s):  
Wei Ye ◽  
Yafang Liu ◽  
WeiFeng Liu ◽  
XiaoLong Li ◽  
Yanqiang Fei ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Meta Analysis ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Scarf Osteotomy ◽  
Randomized Controlled ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Abstract Background Scarf and Chevron Osteotomy have been widely used for Hallux Valgus Deformity(HVD) to correcting hallux valgus angle (HVA) and intermetatarsal 1-2 angle (IMA), but there still have controversy which approach is the best way to repair HVD,this study aims to use meta-analysis to evaluate the clinical outcomes of Scarf and Chevron Osteotomy for Hallux Valgus Deformity.Methods Pubmed, Embase, Medline and Cochrane library databases were searched for relevant studies published before September 1, 2019. Studies clearly reporting a comparison of Scarf and Chevron Osteotomy for Hallux Valgus Deformity were selected. The Post-operative hallux valgus angle (HVA) and intermetatarsal 1-2 angle (IMA) were evaluated and also the correction of HVA and IMA. The weighted mean differences and relative risks were calculated using a fixed-effects or random-effects model.Results Five studies were included in this meta-analysis,one were prospective randomized controlled trials and three were randomized control trials.A total of 434 patients (210 Scarf and 224 Chevron) were enrolled in the studies.Compare Scarf Osteotomy,Chevron Osteotomy can significantly decreaseed Post-operative hallux valgus angle (HVA)[MD = 1.92 95% CI (1.21 to 2.63),P < 0.0001],but there have no significantly difference between Scarf and Chevron Osteotomy groups in terms of Postoperative intermetatarsal angle (IMA),the correction of IMA and HVA(C-IMA/HVA),DMAA,AOFAS and complication incidence[MD = 0.42, 95% CI (-0.34 to 1.17),P=0.28;MD = -0.30, 95% CI (-0.72 to 0.12),P =0.16; MD = -0.88, 95% CI (-2.34 to 0.57),P =0.23;MD = -0.78, 95% CI (-2.29 to 0.72),P =0.31;MD = -2.01, 95% CI (-9.81 to 5.61),P =0.59 and OR=0.80, 95% CI (0.40 to 1.60),P=0.53 respectively].Conclusion Compare Scarf osteotomy,Chevron Osteotomy can significantly decreaseed Post-operative hallux valgus angle (HVA) and other clinical outcomes are similar between the two treatments.

Rotational scarf (Z) osteotomy bunionectomy for correction of high intermetatarsal angles

1992 ◽  
Vol 82 (7) ◽  
pp. 352-360 ◽  
Author(s):  
HF Duke
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Wedge Osteotomy ◽  
Distal Fragment ◽  
Intermetatarsal Angle ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Head Fragment ◽  
Severe Hallux Valgus

A modification of the scarf osteotomy bunionectomy is described. The modification involves a change in the movement of the osseous fragments from lateral transposition to lateral rotation of the metatarsal head fragment around a stationary axis at the metatarsal base. Rotation of the distal fragment in this manner allows greater than 50% transposition and, therefore, higher intermetatarsal angle corrections can be obtained as compared to a transpositional scarf osteotomy. The configuration of the scarf osteotomy is more stable to the stress of weightbearing than the closing base wedge osteotomy, and this modification can provide a useful alternative to closing base wedge osteotomy for the correction of severe hallux valgus deformity.

scholarly journals Is a Flatfoot Associated with a Hallux Valgus Deformity?

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Nicholas Cheney ◽  
Kyle Rockwell ◽  
Joseph Long ◽  
John Weis ◽  
Dylan Lewis ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Radiographic Evidence ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Grand Rapids ◽  
Collapse Model ◽  
Almost All

Category: Bunion Introduction/Purpose: An arch collapse model has been described for a multitude of foot and ankle problems that is based on a gastrocnemius equinus contracture producing a predictable collapse that has been described in five distinct phases. Previous studies have evaluated the presence of pes planovlagus in hallux valgus patients and concluded that this is a rare occurance. The Grand Rapids arch collapse model reviews adult foot pathology and believes there is a link between bunions and flatfeet. We wanted to evaluate patients with flatfeet and determine if they had an associated bunion deformity. Based upon the arch collapse model, there should be a significant number of flatfeet with an associated bunion deformity and our goal was to see if this proved to be true. Methods: We retrospectively reviewed the radiographs of patients diagnosed with a flatfoot based upon their ICD 9 and 10 codes in the senior author’s practice. For each patient, we used standard anteroposterior and lateral foot radiographs obtained on all new patients. Initially, we had 254 feet but had to exclude 93 feet due to inadequate radiographs, normal radiographs (normal meary’s angle and talonavicular coverage angle) or in patients who already had surgical procedures to the foot. This left 161 feet radiographs for review. We then measured the Meary’s angle on the lateral images and the talonavicular coverage angle, hallux valgus angle, intermetatarsal angle and sesamoid position on the anteroposterior radiographs. Results: Of the 161 feet that remained in the study, only 6 feet (3.7%) had no radiographic evidence of a bunion based upon sesamoid position, hallux valgus angle or the intermetatarsal angle. We did find a correlation with the severity of the flatfoot based upon the Meary’s angle and the talonavicular coverage angle with the severity of the bunion deformity defined by the sesamoid position, hallux valgus angle and the intermetatarsal angle. As the flatfoot got worse, the bunion did so as well. Conclusion: Our findings would seem to fit with the Grand Rapids arch collapse model. The hypermobility of the first ray that creates the bunion deformity then allows the arch to ultimately collapse. It also does not seem to contradict what has been found previously. Earlier studies showed a low association between patients with bunions who also had flatfeet. This would make sense as the deformity may not have progressed to the flatfoot yet. However, in our study the deformity has already progressed to a flatfoot and almost all have some radiographic evidence of a bunion.

scholarly journals Intermetatarsal Angle and Hallux Abductus Angle Reduction After First Metatarsophalangeal Joint Arthrodesis in Mild, Moderate, and Severe Hallux Valgus

2021 ◽  
Vol 111 (2) ◽  
Author(s):  
Kimberly S. Cravey ◽  
Ian M. Barron ◽  
Said A. Atway ◽  
Michael L. Anthony ◽  
Erik K. Monson
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
First Ray ◽  
Severe Hallux Valgus ◽  
Preoperative Deformity

Background First metatarsophalangeal joint fusion is a commonly used procedure for treating many pathologic disorders of the first ray. Historically, hallux valgus deformity with severely increased intermetatarsal angle or metatarsus primus adductus indicated need for a proximal metatarsal procedure. However, the effectiveness and reliability of first metatarsophalangeal joint arthrodesis in reducing the intermetatarsal angle has been increasingly described in the literature. We compared findings at our institution with current literature for further validation of this well-accepted procedure in correcting hallux valgus deformity with high intermetatarsal angle. Methods Weightbearing preoperative and postoperative radiographs of 43 patients, 31 women and 12 men, meeting the inclusion and exclusion criteria were identified. Two independent investigators measured the hallux abductus and intermetatarsal angles. Preoperative and postoperative measurements for each angle were compared and average reduction calculated. The data were further analyzed by grouping deformities as mild, moderate, and severe. Mean follow-up was 10 months. Results The overall mean preoperative intermetatarsal and hallux abductus angles decreased significantly (from 13.09° to 9.33° and from 23.72° to 12.19°, respectively; both P &lt; .01). When grouping deformities as mild, moderate, and severe, all of the categories maintained reduction of intermetatarsal and hallux abductus angles (P &lt; .01). Furthermore, the mean reduction of the intermetatarsal and hallux abductus angles seemed to correlate with preoperative deformity severity. Conclusions In patients undergoing correction of hallux valgus deformity, first metatarsophalangeal joint arthrodesis produced consistent reductions in the intermetatarsal and hallux abductus angles. Furthermore, these findings are consistent with those reported by other institutions.

Radiographic Assessment of the Second Metatarsal: Measure of First Ray Hypermobility

1996 ◽  
Vol 17 (6) ◽  
pp. 331-333 ◽  
Author(s):  
David W. Prieskorn ◽  
Roger A. Mann ◽  
Germaine Fritz
Keyword(s):  
Hallux Valgus ◽  
Cortical Thickness ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Second Metatarsal

Hypermobility of the first metatarsal cuneiform joint has been implicated as a cause of the hallux valgus deformity. The objective definition of hypermobility at this joint, however, has not been clearly defined. We used a modified Coleman block test to accentuate motion at the first metatarsal cuneiform joint in order to measure physiologic limits of motion in vivo. This motion was compared with radiographic analysis of the feet, which included the hallux valgus angle, intermetatarsal angle, and medial cortical thickening at the midshaft of the second metatarsal. This assessment was performed on 100 feet (50 right feet and 50 left feet in 50 patients). The average intermetatarsal angle was 8.7° (range, 4–14°), the average hallux valgus angle was 11° (range, 4° of varus to 30° of valgus), and the average midshaft medial cortical thickness was 3.2 mm (range, 2.0–5.5 mm). Pearson's correlation coefficient was calculated to compare these factors. The relationship between variables was found to be small ( r ≤ 0.2). Motion was noted to occur in the normal foot at this joint and a range of normal values for medial cortical thickness was identified.

Correlation analysis of functional and X-ray morphological parameters from the results of Scarf osteotomy of the first metatarsal

2020 ◽  
pp. 44-53
Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova
Keyword(s):  
Hallux Valgus ◽  
Pain Syndrome ◽  
Functional Results ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Hallux valgus (deformity at the base of the big toe) is manifested by a sharp pain syndrome, difficulty in movement, a cosmetic defect on the medial surface of the big toe. This pathology reduces the quality of life of patients, and is also socially significant, since it often occurs in young and middle-aged women who belong to the able-bodied population. In this regard, metaphyseal and diaphyseal osteotomy for the treatment of Hallux valgus of varying degrees, such as surgery according to the Scarf method, is of great importance. Advantages of this surgery are associated with the ability to share the load across the entire osteotomy area, great stability and reliable compression in the fracture zone, which allows early postoperative loading. With increasing age of a patient, a greater correction of the HVA (Hallux Valgus Angle) after osteotomy is achieved. A clearly traced correlation between age and good functional results after Scarf osteotomy allows us to recommend Scarf surgery for elderly patients.

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