Scarf Osteotomy with or without Proximal Phalangeal Osteotomy for Severe Hallux Valgus Deformity

Abstract

Purpose. To report outcome of Scarf osteotomy with or without proximal phalangeal osteotomy for correction of severe hallux valgus deformity. Methods. Records of 48 women and 4 men aged 28 to 68 (mean, 52) years who underwent 57 Scarf osteotomies with or without proximal phalangeal osteotomy for severe hallux valgus by a single surgeon were reviewed. The patients had a hallux valgus angle (HVA) of up to 55º. An additional proximal phalangeal osteotomy was performed in 11 of the patients whose hallux valgus persisted (HVA >10º). The American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, the HVA and intermetatarsal angle (IMA) on radiographs, and the complication rate were assessed. Results. The mean follow-up period was 26 (range, 24-36) months. The mean AOFAS hallux score improved from 57.4 (range, 49-64) to 91.6 (range, 75-100). The mean HVA improved from 38.1º (range, 28º-52º) to 12.8º (range, 5º-20º improved from 17.0º (range, 13º-24º) to 6.8º (range, 3º-10º). One patient developed chronic regional pain syndrome. There were no instances of non-union, delayed union, or malunion of the osteotomy site. Conclusion. Scarf osteotomy with or without proximal phalangeal osteotomy is an effective treatment for correcting severe hallux valgus deformity.

Introduction the revolving scarf osteotomy for treating severe hallux valgus with an increased distal metatarsal articular angle: a retrospective cohort study

“…The postoperative FML was shorter than the preoperative FML in the DMO group, while it was longer in the RSO group after the operation. It was confirmed that the onset of metatarsalgia is related to shortening of the first metatarsal [34, 39]. In theory, the incidence of transfer metatarsalgia should be more in the DMO group, and we found only one patient with such pain; this incidence (3.3%) is lower than that reported by Park and Lee (8.7%) [15].…”

“…Third, in the longitudinal osteotomy, the tail of the micro-swing saw raised and the osteotomy is performed from the inner top to the outer bottom; otherwise the first metatarsal head may be raised, causing transfer metatarsalgia [33]. Fourth, combining a scarf osteotomy with an Akin osteotomy will not affect the blood supply [34] and so should be recommended. Fifth, the medial cutaneous nerve should be protected due to the long medial incision; otherwise, the incision will be painful for a long time after the operation.…”

“…Our osteotomy method improved the three main radiographic parameters of HV: HVA, IMA, and DMAA. The IMA and HVA are objective parameters for assessing corrections performed in each type of osteotomy [24, 25], while the DMAA is commonly used to quantify articular deformity [34, 35]. The DMAA is one of the most important radiographic angles in HV, and it has been shown that non-correction of DMAA alterations is associated with early recurrence of the deformity, reduced range of motion of the metatarsophalangeal joint, and pain [36–38], and so correcting the increased DMAA is key to a satisfactory surgical outcome.…”

Results of Scarf Osteotomy Without Implant Fixation in the Treatment of Hallux Valgus

“…13,20 In the literature, the majority of studies demonstrate good short, intermediate, and longterm results of the treatment of moderate to severe hallux valgus deformities. 2,3,7,12,14,17,22 Over the past decades, 2-screw internal fixation of scarf osteotomy was routine. However, many technical improvements were developed in the last 20 years.…”