J Korean Foot Ankle Soc.  2020 Dec;24(4):135-141. 10.14193/jkfas.2020.24.4.135.

Comparative Analysis of the Results between the Early Period and the Midterm Period of a Single Surgeon’s Experience in the Treatment of Hallux Valgus Using Scarf Osteotomy

• Lee YH
• Nam IH
• Lee TH
• Ahn GY
• Lee YS
• Hwang SH
• Lee KJ

• KMID: 2509534
• DOI: http://doi.org/10.14193/jkfas.2020.24.4.135

Abstract

Purpose
This study evaluated the results of two groups—the early group and midterm group—comparatively in the treatment of hallux valgus using a scarf osteotomy.
Materials and Methods
From January 2005 to December 2009 (Group 1) and from January 2010 to December 2013 (Group 2), this study compared hallux valgus cases treated by a scarf osteotomy by a single surgeon with at least a five-year follow-up.
Results
The average ages of Group 1 and Group 2 were 50.5 and 51.7 years old, respectively. The average follow-up of Groups 1 and 2 were 7.4 and 6.2 years, respectively. Groups 1 and 2 had 86 cases (53 patients) and 93 cases (64 patients) with at least a five-year followup, respectively. The average hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA) of Group 1 were improved from 31.3° and 13.9° preoperatively to 11.3° and 6.8° at the final follow-up, respectively (p<0.001). The average HVA and 1-2 IMA of Group 2 were improved from 31.7° and 13.4° preoperatively to 8.9° and 6.6° at the final follow-up, respectively (p<0.001). The mean American Orthopaedic Foot and Ankle Society (AOFAS) score of both groups increased from 48.5 and 45.0 points preoperatively to 73.7 and 82.4 points at the final follow-up, respectively. The numbers of patient-assessed subjective satisfaction of Groups 1 and 2 at the final follow-ups were as follows: excellent, 27 and 36 (31.4%, 38.7%); good, 34 and 49 (39.5%, 52.7%); fair, 13 and 5 (15.1%, 5.4%); poor, 12 and 3 (13.9%, 3.2%); respectively. Neither troughing nor stress fractures occurred in both groups.
Conclusion
Scarf osteotomy for treating hallux valgus is an excellent surgical method with a relatively low incidence of complications. The results in Group 2 were better than those in Group 1, showing that more surgical experience and evolution of the techniques provided better results.

Keyword

Hallux valgus; Osteotomy; Postoperative complications

Figure

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  Fig. 1 The release of lateral collateral ligament of the first metatarsophalangeal joint by inserting the periosteal elevator (A, B) and scraping the ligament (C). This procedure could weaken the lateral tension around the first metatarsophalangeal joint.

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  Fig. 2 (A) Lowering during scarf osteotomy in group 1. The plantar head fragment was lowered a maximum of 7 mm with the longitudinal cut angle of 20°. Too much lowering occasionally caused metatarsalgia of the first metatarsophalangeal joint. (B) Lowering during scarf osteotomy in group 2. The plantar head fragment was lowered a maximum of only 5 mm, because of reduced longitudinal cut angle about 10° to prevent too much lowering.

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  Fig. 3 Box plot diagram of preoperative and postoperative. HVA and IMA in both groups. (A) Comparative analysis of the HVA of both groups. (B) Comparative analysis of the IMA of both groups. HVA: hallux valgus angle, IMA: intermetatarsal angle. *Statistically significant (p<0.05).

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  Fig. 4 (A) Postoperative evaluation criteria for the results of HVA—negative, normal (0°~20°), and more than 20°. (B) Postop-erative evaluation criteria for the results of IMA—within 8° and more than 8°. HVA: hallux valgus angle, IMA: intermetatarsal angle.

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  Fig. 5 Different options of the shortening of the first metatarsal bone during lateral translation of the plantar head fragment to correct the hallux valgus deformity, depends on the necessity of the length of the shortening. (A) Minimal shortening (1~2mm). (B) Shortening by making the angle of the transverse cut more acute and proximal ward (3~4 mm). (C) Shortening by segmental resection of both ends of the fragments (more than 5 mm).

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  Fig. 6 (A) Long oblique transverse cut makes two cones to prevent troughing and stress fracture. (B) Transverse cut parallel to the shaft makes two half domes leading to troughing distally and stress fracture proximally due to lack of lateral strut.

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  Fig. 7 The relaxed intrinsic muscle of the first ray after shortening the first metatarsal. It produced the relaxed stability along the first metatarsophalangeal joint.

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