J Korean Foot Ankle Soc.  2016 Dec;20(4):152-157. 10.14193/jkfas.2016.20.4.152.

Shortening Scarf Osteotomy for Treatment of Hallux Rigidus Deformity

• Lee YH
• Ahn GY
• Nam IH
• Lee TH
• Lee YS
• Kim DG
• Lee YH

• KMID: 2362762
• DOI: http://doi.org/10.14193/jkfas.2016.20.4.152

Abstract

PURPOSE
To evaluate the effect of shortening scarf osteotomy on pain relief and range of motion (ROM) of the first metatarsophalangeal joint in hallux rigidus patients.
MATERIALS AND METHODS
Twenty-three cases of 19 patients who had been treated with shortening scarf osteotomy for the hallux rigidus between January 2007 and December 2013 were reviewed. The mean follow-up period was 21.4 months, and the mean age was 59.2 years. The first metatarsal bone was shortened until the ROM of the first metatarsophalangeal joint was greater than 80° or 40° of dorsiflexion. The length shortened by scarf osteotomy was measured. The authors also measured and compared the joint interval difference of the standing foot using an anteroposterior radiography. Moreover, the difference of ROM of the first metatarsophalangeal joint between the preoperative and final follow-up periods was also compared. The clinical results were evaluated and compared using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and visual analogue scale (VAS) score.
RESULTS
The mean shortening length was about 6.5 mm (range, 4∼9 mm). The joint space has been increased to 1.8 mm, and the ROM of the first metatarsophalangeal joint has also been increased to 18.4° after the operation. In three cases, the postoperative ROM has been decreased to less 10°. The AOFAS score has been improved from 41.7 (range, 32∼55) to 86.2 (range, 65∼95), and the VAS score was also decreased from 3.7 (range, 3∼5) to 1.3 (range, 0∼3). Two cases have shown no decrease in pain even after the operation.
CONCLUSION
Shortening scarf osteotomy was found to decrease joint pain by decompressing the pressure of the first metatarsophalangeal joint. This osteotomy also helped improve the ROM of the first metatarsophalangeal joint. Shortening scarf osteotomy can be considered one of the effective methods for joint preservation.

Keyword

First metatarsophalangeal joint; Hallux rigidus; Scarf osteotomy; Shortening

MeSH Terms

Ankle
Arthralgia
Congenital Abnormalities*
Follow-Up Studies
Foot
Hallux Rigidus*
Hallux*
Humans
Joints
Metatarsal Bones
Metatarsophalangeal Joint
Osteotomy*
Radiography
Range of Motion, Articular

Figure

• 

  Figure 1. Osteotomy was made from distal part 5∼6 mm of the first metatarsal base in plantar side and proximal part 2∼3 mm of the 1st metatarsal pole in dorsal side. Then, we did oblique longitudinal osteotomy from these points in medial side.

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  Figure 2. To be parallel to the plantar plane, the longitudinal osteotomy line was rotated about coronal 20°∼30° and completed from medial (A) to lateral cortex (B).

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  Figure 3. (A) Preoperative range of motion (ROM) of the first metatarsophalangeal (MTP) joint was limited. (B) We shortened the first metatarsal bone until ROM of the 1st MTP joint was normal (80°).

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  Figure 4. If range of motion is uncheckable due to joint stiffness, we cut the first metatarsal bone with same length of proximal and distal part (A). Then, we shortened from proximal (B) to distal portion (C). After acquiring at least 40° dorsiflexion, bony fragments were fixed by screw fixation (D).

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  Figure 5. The 1st metatarsal length was measured between preoperative (A) and postoperative radiographs (B). The average 6.5 mm (4∼9 mm) was shortened after operation.

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  Figure 6. (A, B) The first joint space widening was also evaluated (arrows). The average length 1.8 mm (0.5∼2.5 mm) was widened by scarf osteotomy.

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