Introduction: Scarf osteotomy is a zosteotomy of 1st metatarsal and is proposed to correct anatomical and functional deformities of hallux valgus. This procedure allows early ambulation without cast and early return of function. However, this is a technically demanding procedure. This study was conducted to evaluate clinical and paedobarographic results following this procedure in a district general hospital. Method and materials: We prospectively collected the data from 71 feet in 54 patients. We collected the AOFAS scores preoperatively, 3 and 6 months. Hallux vagus, 1–2 intermetatarsal angles and sesamiod subluxation were measured from weight bearing radiographs taken preoperatively, 6 weeks and 6 months. We evaluated the forefoot function using peak pressure, force time integral and pressure time integral parts of paedobarographs (Musgrave) preoperatively, 3 and 6 months. Results: Total AOFAS score increased from 43.11 preoperatively to 84.96 at 3 months postoperatively (p< 0.0001, 95% CI of 44.5 to 35.5). The hallux valgus angle decreased from 30.1 to 9.92 at 6 weeks post operatively (p< 0.0001, 95% CI of 22.21 to 18.27). The mean peak pressure under the 1st metatarsal head was reduced from 3.09 (95% CI 2.49 Ð3.70) to 2.25 (95% CI1.80–2.71) at 6 months. The mean peak pressure under the 2nd metatarsal head was reduced from 6.29(95% CI 5.44–7.13) to 5.01 (95% CI 3.98–6.05) at 6 months. Force time and Pressure time integrals also showed similar changes. Conclusions: Scarf osteotomy produced improvement in the postoperative scores, radiological angles and forefoot pressures. In conclusion, scarf osteotomy is a versatile and reliable procedure in the management of hallux valgus.

Introduction

Hallux Valgus was thought to alter the forefoot function with defuctioning of the first ray with a resulting overloading of the second ray. The scarf osteotomy is a z-osteotomy of the first metatarsal and is proposed to correct anatomical and functional deformities of hallux valgus. This study was conducted to evaluate forefoot pressures using the Musgrave foot print system following this procedure in a district general hospital.

Method

We prospectively collected the data from 43 feet in 31 consecutive patients. We evaluated the forefoot function using peak pressure, force time integral and pressure time integral parts of pedobarographs (Musgrave) pre-operatively, three and six months postoperatively.

Results

The mean peak pressure under the first metatarsal head was reduced from 3.09 (95% CI 2.49 −3.70) to 2.25 (95% CI1.80–2.71) at six months. The mean peak pressure under the second metatarsal head was reduced from 6.29 (95% CI 5.44–7.13) to 5.01 (95% CI 3.98–6.05) at six months. Force time integral under the first metatarsal head was reduced from 1.34 (95% CI 1.06–1.62) to 0.97 (95% CI 0.74–1.19)) at six months. Force time integral under the second metatarsal head also reduced from 2.66 (95% CI 2.27–3.06) to 2.41(95% CI 1.98–2.85). Pressure time integrals also showed similar changes.

Conclusion

Scarf osteotomy produced decrease in the forefoot pressures under the medial part of forefoot. We have not noticed significant alteration of forefoot pressures under the lateral part of forefoot.

Introduction

The scarf osteotomy is a z-osteotomy of the first metatarsal. This is a technically demanding procedure which allows early ambulation without cast and early return of function. This study was conducted to evaluate clinical results following this procedure in a district general hospital.

Method

We prospectively collected the data from 67 feet in 53 consecutive patients followed up for six months. Four patients were lost to follow up. We collected the AOFAS score preoperatively, and at three and six months. Hallux valgus angle, first-second intermetatarsal angle and sesamoid subluxation were measured from weight bearing radiographs taken preoperatively and at six weeks and six months.

Results

Total AOFAS score increased from 43.1 preoperatively to 85.0 at three months postoperatively (p< 0.0001, 95% CI of 44.5 to 35.5). The AOFAS scores at three and six months also showed significant difference (p< 0.0001, 95% CI of 4 to 10). All the components of AOFAS showed similar improvement postoperatively. The hallux valgus angle decreased from 30.1 to 9.9 degrees at six weeks post operatively (p< 0.0001, 95% CI of 22.21 to 18.27). The first-second intermetatarsal angle decreased from 12.6 to 6.4 at 6 weeks post operatively (p< 0.0001, 95% CI of 5.1 to 7.14). Sesamoid subluxation was reduced in the majority of cases. We had two fractures of the metatarsal head, three wound infections and six cases of transient neuropraxia of the cutaneous nerves.

Conclusion

With Scarf osteotomy, we achieved good correction of the hallux valgus deformity and significant improvement of AOFAS score. It is a versatile and reliable procedure in the management of hallux valgus.