Scarf and Akin Osteotomies for Correction of Hallux Abducto Valgus. A Ten-year Retrospective Patient Evaluation From Five Podiatric Surgery Centres Using PASCOM PSQ-10.

BackgroundCorrective surgery for hallux abducto valgus is one of the most commonly performed elective procedures in foot and ankle practice, with over a hundred different surgical solutions having been proposed throughout the literature. The purpose of the study was to identify the clinical and patient reported outcomes following Scarf-Akin osteotomies from five podiatric surgery centres over a ten-year period.MethodThis is a retrospective review from five podiatric surgical units which looked at patients who underwent Scarf osteotomies (in isolation or in combination with Akin procedures) over a ten-year period. Data was collected from the patient satisfaction questionnaires of the PASCOM-10 audit tool, which were completed by the patient six months post operatively, and further analysed using Microsoft Excel spreadsheet software.ResultsA total of 1351 patients were recorded undergoing Scarf (with or without an Akin) osteotomy for hallux abducto valgus, with 1227 females (90.83%) and 124 males (9.17%) identified but with only 1189 who had completed the patient satisfaction questionnaire. 96.8% of patients felt that their foot was either ‘better’ or ‘much better’ following surgery and that their original expectations of surgery had been met. Over 75% of patients had no post-operative sequalae identified, with metatarsal fracture noted to be the highest sequalae at 4.8%.ConclusionFrom the five podiatric surgery units reviewed, Scarf osteotomies (with or without an Akin osteotomy) for hallux abducto valgus correction, have a high level of patient satisfaction with low post-operative sequalae.Level of clinical evidenceIV (retrospective review).

Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis

Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who had scarf and Akin osteotomy with intra-articular stepwise lateral soft tissue release between 2015 and 2020 at a single institute were investigated retrospectively, with a mean follow-up period of 32.0 ± 16.9 months. Radiographic evaluations including the HV angle, intermetatarsal angle, and sesamoid position were performed preoperatively and postoperatively. Clinical outcomes were assessed using the Japanese Society of Surgery of the Foot (JSSF) hallux scale and self-administered foot evaluation questionnaire (SAFE-Q). Results. The procedure resulted in significant HV correction, with a recurrence rate of 13.9%. The JSSF scale and all five SAFE-Q subscale scores significantly improved (p < 0.05), with no major complications. More than 90% of cases achieved adequate lateral soft tissue release without sacrificing the adductor tendon of the hallux. Conclusions. Intra-articular stepwise lateral soft tissue release in combination with scarf and Akin osteotomy provided satisfactory radiographic and patient-reported outcomes for the correction of HV in patients with RA with minimum lateral soft tissue release.

Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities

Background: Few studies have reported results of minimally invasive chevron Akin osteotomy (MICA) for moderate to severe hallux valgus correction. This study aims to evaluate MICA for moderate to severe hallux valgus radiographically and clinically. Methods: Forty feet were prospectively reviewed. Twenty-eight feet (70%) had a severe deformity (hallux valgus angle (HVA) ≥40° and/or first intermetatarsal angle (IMA) ≥18°). We measured HVA, IMA, lateral shape of the metatarsal head (round sign), tibial sesamoid position, first metatarsal shortening on anteroposterior weightbearing radiographs, and inclination angle of first metatarsal on lateral weightbearing radiographs. We evaluated the Japanese Society for Surgery of the Foot hallux scale and Self-Administered Foot Evaluation Questionnaire responses preoperatively and at the most recent follow-up. Results: All measurements except shortening and inclination angle improved significantly. Both clinical scale and all subscores significantly improved. Conclusions: MICA improved moderate to severe hallux valgus both radiographically and clinically. Level of Evidence: Level IV: case series

Third-Generation Minimally Invasive Chevron-Akin Osteotomy for Hallux Valgus Produces Similar Clinical and Radiological Outcomes as Scarf-Akin Osteotomy at 2 Years: A Matched Cohort Study

Background: The minimally invasive chevron-Akin (MICA) osteotomy is an increasingly popular technique for the correction of hallux valgus. However, there is a paucity of literature comparing it with traditional open techniques. The purpose of this study was to compare the clinical and radiological outcomes of the MICA osteotomy using a new-generation MICA screw and scarf-Akin osteotomy for hallux valgus correction. Methods: Thirty cases of MICA osteotomy were propensity score matched 1:1 with a control group of 30 scarf-Akin osteotomy cases. The groups were matched for age, sex, body mass index, preoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal-interphalangeal (MTP-IP) score, 36-Item Short-Form Health Survey (SF-36) physical component score (PCS) and mental component score (MCS), preoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), and concomitant procedures. Outcomes were compared at 6 and 24 months postoperatively. Early postoperative VAS scores were also compared. Results: Both groups demonstrated significant improvements in VAS score, AOFAS score, and SF-36 PCS and MCS at 6 and 24 months postoperatively. For the MICA group, HVA improved from 23.5 to 7.7 degrees, and IMA improved from 13.5 to 7.5 degrees. For the scarf-Akin osteotomy group, HVA improved from 23.7 to 9.3 degrees, and IMA improved from 13.6 to 7.8 degrees. The first 24-hour postoperative VAS score was significantly lower in the MICA group compared with the scarf-Akin group (2.0 ± 2.0 vs 3.4 ± 2.6, P = .029). However, there was no significant difference in clinical or radiological outcomes between the groups at 6 and 24 months. Conclusion: The MICA procedure with the new-generation MICA screw is an attractive option for the correction of hallux valgus, yielding similar midterm radiological and clinical outcomes compared with the well-established scarf-Akin osteotomy. The first 24-hour postoperative VAS score in the MICA group was also statistically lower, although its clinical significance remains to be determined. Level of Evidence: Level III, retrospective comparative study.

Minimally invasive chevron/akin osteotomy: radiographic outcomes

Objective: To evaluate radiographic outcomes in patients undergoing minimally invasive Chevron/Akin osteotomy (MICA) for hallux valgus correction. Methods: We have treated 31 patients (40 feet). Preoperative and postoperative hallux metatarsophalangeal angles (hallux valgus angles, HVA), intermetatarsal angles (IMA) between the first and second metatarsals, and distal metatarsal articular angles (DMAA) were followed up for 12 months. Results: The mean age of the patients was 53.2 years. Mean preoperative HVA, IMA, and DMAA values were 28.85°, 15.38°, and 14.35°, respectively. The mean postoperative angles measured after 1 year were 10.60°, 7.95°, and 7.48°. Improvements in HVA, IMA, and DMAA values showed statistical relevance. There were no losses in angular parameters during follow-up. Conclusion: The radiographic outcomes in patients undergoing MICA osteotomy for hallux valgus correction followed up for 12 months showed significant improvements and no recurrence of the deformity. Our results suggest that this technique is effective for correcting hallux valgus. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.

Outcomes after Rotation Scarf with Akin Osteotomy for Severe Hallux Valgus

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.