Elsevier

Foot and Ankle Surgery

Volume 25, Issue 4, August 2019, Pages 469-477
Foot and Ankle Surgery

Scarf versus long chevron osteotomies for the treatment of hallux valgus: A prospective randomized controlled study

https://doi.org/10.1016/j.fas.2018.02.017Get rights and content

Highlights

  • No single osteotomy can address all cases of hallux valgus and treatment should address each patient according to his needs and peculiarities.

  • This is a prospective RCT to compare scarf osteotomy (of good corrective power but technically demanding) to extended chevron (long plantar limb with simpler technique) regarding power of deformity correction, radiological results, patient scoring system and complication rate.

  • Group A (scarf) 21 patients was compared to group B (long chevron) with 22 patients, shorter operative time was in favour of long chevron group.

  • Radiological correction was similar in both groups. Improvement of functional score was more in the long chevron group. Complication rate was similar in both osteotomies.

Abstract

Background

The aim of this study is to compare scarf osteotomy and long chevron osteotomy in treatment of hallux valgus deformity regarding operative time, power of correction and complications.

Design

A prospective randomized controlled comparative trial.

Methods

48 cases with hallux valgus were divided randomly in 2 groups (21 treated by scarf and 22 treated by long chevron osteotomy and 5 were missed during follow up), average age 36 years, follow up time was average of 25.9 months. Patients were assessed clinically, radiologically, and functional scoring system of American College of Foot and ankle Surgeons (ACFAS)was used both pre and postoperatively.

Results

Operative time was 69 min in scarf group compared to 63 min to long chevron group, radiological correction showed no statistically significant difference between both groups while functional improvement in ACFAS score was in favour of long chevron group 69.1% compared to scarf group 57.5%

Conclusions

Both osteotomies possess almost identical corrective power of the IMA (intermetatarsal angle) and similar clinical outcomes with slightly shorter operative time and subjective technical simplicity for the long chevron osteotomy.

Introduction

More than 130 operations have been described for the treatment of hallux valgus. This huge number means that no single procedure can address all cases, and treatment has to be tailored according to each specific patient’s needs and peculiarities. Surgery aims not only to the aesthetic correction of the deformity, but also to a functional painless foot.

The scarf osteotomy is a well-established surgery for hallux valgus, however, it is a technically demanding procedure. The conventional ‘short’ chevron osteotomy [1] is a rather simpler procedure. However, the magnitude of deformity correction is limited [2]. There are also concerns about its healing power and avascular necrosis of the metatarsal head [3], [4].

The long ‘extended plantar limb’ chevron introduced by Mahadevan et al. [5] seems to combine the good of both osteotomies, the simplicity of the chevron with the corrective power and stability of the scarf. The aim of our study is to compare both osteotomies in terms of operative time, functional and radiological outcomes, and complications. Our hypothesis is that long chevron osteotomy combines the good of both worlds in terms of avoiding the complexity of the scarf osteotomy while maintaining the same corrective power.

Section snippets

Study design

This is a prospective randomized controlled trial, designed to compare both osteotomies. The study was conducted in our institution, from January 2013 to January 2015, after the approval of the scientific and ethical committee was obtained.

Patients with painful hallux valgus after failed conservative treatment for 6 months with inter-metatarsal angle (IMAs) between 10 up to 20° aged 18 to 80 were included. We excluded patients with MTP arthrosis, rheumatoid arthritis, paralytic hallux valgus,

Demographic data

A group of 48 patients with hallux valgus were recruited for this study, only 43 patients reached the final follow up (21 in scarf group/22 in long chevron group). The average age was 36, range 18–67 with a standard deviation of 12.16. There were 19 male and 24 female cases. 22 of the feet were right and 21 were left. The average duration of symptoms was 31 months, range 12–60 with a standard deviation of 10.53. 4 cases in each group required additional Akin osteotomy (all of them had IMA > 20°)

5

Discussion

This study has shown that both osteotomies have nearly similar clinical and radiological outcomes and corrective power. However, the technical simplicity reported subjectively by the surgeons performing both osteotomies and shorter operative time favor the long chevron osteotomy. Having a single transverse cut allows combined angulation and translation of the distal end of the bone which offsets its smaller contact surface compared to the scarf. Single screw fixation was possible in the long

Conclusion

We have found out that the two osteotomies possess almost identical corrective power of the IMA and similar clinical outcomes with slightly shorter operative time and subjective technical simplicity for the long chevron osteotomy.

Funding

No financial support was received for this study, the authors have received nothing of value.

Conflict of interest

All authors declare that they have no conflict of interest.

Acknowledgements

We would like to thank Ain Shams University and its hospitals where all of our operations were done by us and under great care and help of our professors, nursing team, residents.

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