Clin Orthop Surg.  2018 Dec;10(4):479-483. 10.4055/cios.2018.10.4.479.

Modified Proximal Scarf Osteotomy for Hallux Valgus

• Young KW
• Lee HS
• Park SC

• KMID: 2426534
• DOI: http://doi.org/10.4055/cios.2018.10.4.479

Abstract

BACKGROUND
We developed a modified proximal scarf osteotomy technique for moderate to severe hallux valgus in an attempt to obtain better correction of the deformity. In addition, we compared the clinical and radiographic results of this modified technique with those of the classic scarf osteotomy reported in other studies.
METHODS
Between December 2004 and July 2009, 44 cases of modified proximal scarf osteotomy was performed in 35 patients with moderate hallux valgus. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of motion of the first metatarsophalangeal joint, and radiographic results were evaluated.
RESULTS
The mean hallux valgus angle and the mean first intermetatarsal angle improved from an average of 32.2° and 14.3°, respectively, to an average of 12.5° and 8.6°, respectively. The distal metatarsal articular angle improved from an average of 18.7° to 12.4°. The preoperative mean AOFAS and VAS scores were 47 points and 7 points, respectively, which improved to 86 points and 1 point, respectively, at the final follow-up. Limited range of motion occurred in two cases postoperatively. The height of the first metatarsal-cuneiform joint, which was an average of 15.9 mm preoperatively, did not change. The first metatarsal-talus angle increased from an average of 4.1° to 7.1°.
CONCLUSIONS
The modified proximal scarf osteotomy for the treatment of moderate hallux valgus showed similar results with the classic scarf osteotomy with regard to changes in the first intermetatarsal angle and postoperative satisfaction. Therefore, we suggest the modified proximal scarf osteotomy be considered as well as other proximal osteotomy in the treatment of moderate to severe hallux valgus.

Keyword

Metatarsal bones; Hallux valgus; Osteotomy

MeSH Terms

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

Figure

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  Fig. 1 (A) Osteotomy site in the original scarf osteotomy located at 20 mm distal to the first metatarsal-cuneiform joint and at 5 mm proximal to the first metatarsophalangeal joint. (B) Osteotomy site in the modified proximal scarf osteotomy located at 5 mm distal to the first metatarsal-cuneiform joint and at 20 mm proximal to the first metatarsophalangeal joint.

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  Fig. 2 (A) Anteroposterior X-ray of the foot before the modified proximal scarf osteotomy. (B) Anteroposterior X-ray of the foot after two cortical screw fixations in the modified proximal scarf osteotomy.

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  Fig. 3 Lateral view of the foot after two cortical screw fixations in the modified proximal scarf osteotomy.

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