Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients

Abstract

BackgroundThe Cochrane review of hallux valgus surgery has disputed the scientific validity of hallux valgus research. Scoring systems and surrogate measures such as x-ray angles are commonly reported at just one year post operatively but these are of dubious relevance to the patient. In this study we extended the follow up to a minimum of 8 years and sought to address patient specific concerns with hallux valgus surgery. The long term follow up also allowed a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies.MethodsBetween 1996 and 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. All patients were contacted and asked to participate in this study. 50 female participants were available allowing review of 73 procedures. The average follow up was over 9 years and the average age at the time of surgery was 57. The participants were physically examined and interviewed.ResultsPost-operatively, in 86% of the participants there were no footwear restrictions. Stiffness of the first metatarsophalangeal joint was reported in 8% (6 feet); 10% were unhappy with the cosmetic appearance of their feet, 3 feet had hallux varus, and 2 feet had recurrent hallux valgus. There were no foot-related activity restrictions in 92% of the group. Metatarsalgia occurred in 4% (3 feet). 96% were better than before surgery and 88% were completely satisfied with their post-operative result. Hallux varus was the greatest single cause of dissatisfaction. The most common adverse event in the study was internal fixation irritation. Hallux valgus surgery is not without risk and these findings could be useful in the informed consent process.ConclusionsWhen combined the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that achieves good long-term correction with a low incidence of recurrence, footwear restriction or metatarsalgia. The nature of the osteotomies allows early return to normal shoes and activity without the need for postoperative immobilisation in a plaster cast.

Surgery for the correction of hallux valgus

“…10 Scarf-Akin osteotomy has been shown to have an 88% satisfaction rating at a mean of nine years post-operatively. 26 Likewise, larger studies than ours exist, with series of 185 feet for Chevron osteotomy, 7 proximal oblique sliding wedge osteotomy in 187 feet, 11 and a series of 1000 feet fol-lowing minimally invasive surgical correction. 9 While all of these studies report good outcomes, the use of AOFAS or an otherwise unvalidated system in each is a limitation.…”

“…This is therefore the largest series currently published using a validated measure allowing new interpretation of the outcome following surgery for this condition. 8,9,11,20,26 Reasonable response rates (83%) were achieved. The rate of complications (6.2%) and recurrence (9.9%) were comparable with other published data.…”

“…The rate of complications (6.2%) and recurrence (9.9%) were comparable with other published data. 26,27,[28][29][30] The MOXFQ was chosen because it has been specifically designed and validated to assess the outcome in hallux valgus. 12 It is a 16-item patient reported outcome tool that incorporates scores for pain, walking or standing, and social interaction, all three of which may be combined to produce a summary score.…”

Impact of podiatry resident experience level in hallux valgus surgery on postoperative outcomes

“…The following observations were recorded from the surgical logs for the principle resident surgeon on record for each procedure: 1) post graduate year of training, 2) number of ‘C level’ HVS cases requiring first metatarsal osteotomy, and 3) number of ‘C level’ + ‘B level’ HVS cases requiring first metatarsal osteotomy. During the time frame covered with this study, the Council of Podiatric Medical Education defined a C level case as “the resident participates actively in performing the procedure.” This level of participation could be claimed on surgical logs when the resident performed at least the majority (greater than fifty percent) of the procedure under direct supervision of the attending (17). B level cases, in contrast, could be claimed by the resident when their participation in the case was less than 50% and typically involved greater amounts of observation.…”

Halluks valgus deformitesinin yaşam kalitesi üzerine etkisi

“…Birinci metatarsofalangeal eklem/HV açısı dijital gonyometre (Şekil 2) ile ayakta dik duruş pozisyonunda ölçülmüştür. Gonyometrenin pivot noktası 1. metatarsofalangeal ekleme yerleştirilmiş, bir kolu 1. metatarsal kemiğe, diğer kolu proksimal falanksa paralel olacak şekilde yerleştirilerek ölçüm gerçekleştirilmiştir (20).…”