Evaluation of diaphyseal osteotomies for correction of moderate to severe hallux valgus: Scarf and Modified Chevron osteotomies
DOI:
https://doi.org/10.1016/j.rccot.2016.01.003Keywords:
hallux valgus, first metatarsal osteotomies, AOFAS scale, metatarsophalangeal angle, inter-metatarsal angle, hallux distal angleAbstract
Background: The aim of the study was to compare functional and radiological outcomes during the first postoperative year between two different first metatarsal osteotomies (modified Chevron vs. Scarf) in patients with moderate and severe hallux valgus, in Hospital de San José between January 2010 and January 2013.
Materials and methods: An observational cohort study was conducted on the radiological measurements pre-operatively, at 6 weeks post-operatively, and at 12 months. The functional measurements were made pre-operatively and at 12 months postoperatively, using the American Orthopaedic Foot and Ankle Society (AOFAS) scale. A comparison was made of the two diaphyseal first metatarsal osteotomies in patients with moderate and severe hallux valgus, performed randomly by three sub-specialists surgeons in foot and ankle surgery.
Results: A total of 69 feet were included from 57 patients with a mean age of 50.8 years, who underwent, equally, one of the two selected surgical techniques. No significant differences were found between the two techniques on comparing the radiological measurements and AOFAS functional scale at 6 weeks and 12 months. There was higher recurrence rate for the modified Chevron technique, 19.35% compared with 5.26% with the Scarf.
Discussion: The comparison of radiological and functional measurements at 1 year follow-up between Chevron and Scarf osteotomies to correct moderate to severe hallux valgus in the Hospital of San José show similar results, but the recurrence rates for modified Chevron technique are three times higher than those found in treatment with Scarf osteotomy.
Evidence level II.
Downloads
References
Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg Am. 2011;93:1650-61. https://doi.org/10.2106/JBJS.H.01630
Easley ME, Trnka HJ. Current concepts review: hallux valgus part 1: pathomechanics, clinical assessment, and nonoperative management. Foot Ankle Int. 2007;28:654-9. https://doi.org/10.3113/FAI.2007.0654
Mann RA. Disorders of the first metatarsophalangeal joint. J Am Acad Orthop Surg. 1995;3:34-43. https://doi.org/10.5435/00124635-199501000-00005
Mann RA, Coughlin MJ. Hallux valgus-etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res. 1981;3:1-41. https://doi.org/10.1097/00003086-198106000-00008
Coughlin MJ, Roger A. Mann Award Juvenile hallux valgus: etiology and treatment. Foot Ankle Int. 1995;16:682-97. https://doi.org/10.1177/107110079501601104
Sammarco VJ. Surgical correction of moderate and severe hallux valgus: proximal metatarsal osteotomy with distal soft-tissue correction and arthrodesis of the metatarsophalangeal joint. Instr Course Lect. 2008;57:415-28.
Sanhudo JAV. Modificação da osteotomia em "chevron" para correção do hálux valgo moderado a grave. A modification of the chevron osteotomy for moderate to severe hallux valgus. Rev Bras Ortop. 2005;40: 297-304.
Easley ME, Trnka HJ. Current concepts review: hallux valgus part II: operative treatment. Foot Ankle Int. 2007;28:748-58. https://doi.org/10.3113/FAI.2007.0748
Trnka HJ. Osteotomies for hallux valgus correction. Foot Ankle Clin. 2005;10:15-33. https://doi.org/10.1016/j.fcl.2004.10.002
Zembsch A, Trnka HJ, Ritschl P. Correction of hallux valgus. Metatarsal osteotomy versus excision arthroplasty. Clin Orthop Relat Res. 2000;376:183-94. https://doi.org/10.1097/00003086-200007000-00025
Lin JS, Bustillo J. Surgical treatment of hallux valgus: a review. Curr Opin Orthop. 2007;18:112-7. https://doi.org/10.1097/BCO.0b013e328082e2b6
Ferrari J, Higgins JP, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database Syst Rev. 2004;1:CD000964. https://doi.org/10.1002/14651858.CD000964.pub2
Okuda R, Kinoshita M, Morikawa J, Jotoku T, Abe M. Distal soft tissue procedure and proximal metatarsal osteotomy in hallux valgus. Clin Orthop Relat Res. 2000;379:209-17. https://doi.org/10.1097/00003086-200010000-00024
Acevedo JI, Sammarco VJ, Boucher HR, Parks BG, Schon LC, Myerson MS. Mechanical comparison of cyclic loading in five different first metatarsal shaft osteotomies. Foot Ankle Int. 2002;23:711-6. https://doi.org/10.1177/107110070202300806
Crevoisier X, Mouhsine E, Ortolano V, Udin B, Dutoit M. The scarf osteotomy for the treatment of hallux valgus deformity: a review of 84 cases. Foot Ankle Int. 2001;22:970-6. https://doi.org/10.1177/107110070102201208
Robinson AH, Bhatia M, Eaton C, Bishop L. Prospective comparative study of the scarf and Ludloff osteotomies in the treatment of hallux valgus. Foot Ankle Int. 2009;30:955-63. https://doi.org/10.3113/FAI.2009.0955
Kristen KH, Berger C, Stelzig S, Thalhammer E, Posch M, Engel A. The SCARF osteotomy for the correction of hallux valgus deformities. Foot Ankle Int. 2002;23:221-9. https://doi.org/10.1177/107110070202300306
Sammarco VJ, Acevedo J. Stability and fixation techniques in first metatarsal osteotomies. Foot Ankle Clin. 2001;6:409-32. https://doi.org/10.1016/S1083-7515(03)00105-0
Schwartz N. Scarf bunionectomy. Techniques of osteotomies on the forefoot. Burdeos: AFCP spring meeting; 1994. p. 118.
Sanhudo JA. Correction of moderate to severe hallux valgus deformity by a modified chevron shaft osteotomy. Foot Ankle Int. 2006;27:581-5. https://doi.org/10.1177/107110070602700803
Sangeorzan BJ, Hansen ST Jr. Modified Lapidus procedure for hallux valgus. Foot Ankle. 1989;9:262-6. https://doi.org/10.1177/107110078900900602
Lian GJ, Markolf K, Cracchiolo A 3rd. Strength of fixation constructs for basilar osteotomies of the first metatarsal. Foot Ankle. 1992;13:509-14. https://doi.org/10.1177/107110079201300904
Torkki M, Malmivaara A, Seitsalo S, Hoikka V, Laippala P, Paavolainen P. Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. JAMA. 2001;285:2474-80. https://doi.org/10.1001/jama.285.19.2474
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349-53. https://doi.org/10.1177/107110079401500701
Weil LS. Scarf osteotomy for correction of hallux valgus. Historical perspective, surgical technique, and results. Foot Ankle Clin. 2000;5:559-80.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Revista Colombiana de ortopedia y traumatología

This work is licensed under a Creative Commons Attribution 3.0 Unported License.