Short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures in treatment of hallux valgus associated with mild to moderate metatarsus adductus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QU Fufeng ¹ , CAI Jie ¹ ,  LIANG Xiaojun ² , LU Jun ² , ZENG Qiu ² , JI Weina ²

1. Xi’an Medical University, Xi’an Shaanxi, 710068, P.R.China;
2. Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

LIANG Xiaojun, Email: hhyyqff@163.com

Keywords：

Metatarsus adductus; hallux valgus; Scarf osteotomy; Akin osteotomy

DOI：

10.7507/1002-1892.201804046

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Objective To evaluate the short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus. Methods The clinical data of 30 patients (48 feet) who were diagnosised hallux valgus associated with mild to moderate metatarsus adductus and treated by Scarf osteotomy and Akin osteotomy combined with soft tissue procedures between February 2013 and May 2015 were analyzed retrospectively. There were 2 males (2 feet) and 28 females (46 feet) with an average age of 29.4 years (range, 18-50 years). The disease duration was 3-12 years (mean, 6.1 years). The degree of metatarsal adductus was assessed by Sgarlato’s measurement and Yu et al classification criteria, and the degree of metatarsal adductus was mild in 20 feet and moderate in 28 feet. Preoperative X-ray examination showed that the hallux valgus angle (HVA) was (39.4±5.6)°, the first-second intermetatarsal angle (1-2IMA) was (15.2±3.5)°, the metatarsus adductus angle (MAA) was (21.2±3.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 51.7±10.0, and visual analogue scale (VAS) score was 4.9±2.7 before operation. Postoperative complications and the union time of osteotomies were recorded. At last follow-up, the HVA, 1-2IMA, and MAA were measured on X-ray films, and the AOFAS scores and VAS scores were recorded, then compared them with preoperative ones. Roles - Maudsley score was used to investigate patients’ satisfaction. Results All the incisions healed by first intention. Thirty patients were followed up 24-27 months (mean, 26.4 months). Three patients (4 feet) occured metatarsalgia, and the pain relieved after treated by Custom-Made Orthotics. All the osteotomies were unoin, the healing time was 2-4 months (mean, 2.7 months). At last follow-up, the HVA and the 1-2IMA were (13.2±3.1)° and (5.1±2.3)°, respectively, showing significant differences when compared with preoperative ones (t=14.606, P=0.000; t=22.356, P=0.000); the MAA was (21.0±3.4)° and there was no significant difference when compared with preoperative one (t=0.789, P=0.434). The AOFAS and VAS scores were 91.8±7.5 and 1.1±1.0, respectively, showing signifiant differences when compared with preoperative ones (t=13.787, P=0.000; t=14.781, P=0.000). Satisfaction survey showed that 28 patients were very satisfied and satisfied (93.3%), and 2 cases were not satisfied (6.7%). Conclusion The short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus is satisfactory, and no correction is required for metatarsal adductus.

Citation： QU Fufeng, CAI Jie, LIANG Xiaojun, LU Jun, ZENG Qiu, JI Weina. Short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures in treatment of hallux valgus associated with mild to moderate metatarsus adductus. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(11): 1392-1396. doi: 10.7507/1002-1892.201804046 Copy

1.	王正义. 足踝外科学. 北京: 人民卫生出版社, 2014: 117-119.
2.	Ferrari J, Malone-Lee J. A radiographic study of the relationship between metatarsus adductus and hallux valgus. J Foot Ankle Surg, 2003, 42(1): 9-14.
3.	La Reaux RL, Lee BR. Metatarsus adductus and hallux abducto valgus: their correlation. J Foot Surg, 1987, 26(4): 304-308.
4.	Kilmartin TE, Barrington RL, Wallace WA. Metatarsus primus varus. A statistical study. J Bone Joint Surg (Br), 1991, 73(6): 937-940.
5.	Chen L, Wang C, Wang X, et al. A reappraisal of the relationship between metatarsus adductus and hallux valgus. Chin Med J (Engl), 2014, 127(11): 2067-2072.
6.	Larholt J, Kilmartin TE. Rotational scarf and akin osteotomy for correction of hallux valgus associated with metatarsus adductus. Foot Ankle Int, 2010, 31(3): 220-228.
7.	Yu GV, DiNapoli DR. Surgical management of hallux abductovalgus with concomitant metararsus adductus//McGlamry ED, ed. Reconstructive surgery of the foot and leg: update’89. Tucker (GA): Podiatry Institute, 1989: 262-268.
8.	Dawoodi AI, Perera A. Reliability of metatarsus adductus angle and correlation with hallux valgus. Foot Ankle Surg, 2012, 18(3): 180-186.
9.	Roles NC, Maudsley RH. Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment. J Bone Joint Surg (Br), 1972, 54(3): 499-508.
10.	Aiyer AA, Shariff R, Ying L, et al. Prevalence of metatarsus adductus in patients undergoing hallux valgus surgery. Foot Ankle Int, 2014, 35(12): 1292-1297.
11.	陈立, 马昕, 王旭, 等. 合并跖内收畸形对踇翻治疗效果的影响. 足踝外科电子杂志, 2015, 2(1): 26-29.
12.	Schneider W. Distal soft tissue procedure in hallux valgus surgery:biomechanical background and technique. Int Orthop, 2013, 37(9): 1669-1675.
13.	黄加张, 马昕, 王旭, 等. Akin 截骨术在拇外翻手术应用的探讨. 中国骨与关节外科, 2012, 5(2): 150-153.
14.	Malviya A, Makwana N, Laing P. Scarf osteotomy for hallux valgus—is an Akin osteotomy necessary? Foot Ankle Surg, 2007, 13(4): 177-181.
15.	Aiyer A, Shub J, Shariff R, et al. Radiographic recurrence of deformity after hallux valgus surgery in patients with metatarsus adductus. Foot Ankle Int, 2015, 37(2): 165-171.
16.	Shima H, Yasuda T, Mori K, et al. Surgical procedures and outcomes in the treatment of hallux valgus with metatarsus adductus. Foot Ankle Surg, 2017, 23(S1): 79.
17.	Tóth K, Huszanyik I, Kellermann P, et al. The effect of first ray shortening in the development of metatarsalgia in the second through fourth rays after metatarsal osteotomy. Foot Ankle Int, 2007, 28(1): 61-63.
18.	Sharma J, Aydogan U. Algorithm for severe hallux valgus associated with metatarsus adductus. Foot Ankle Int, 2015, 36(12): 1499-1503.
19.	Kuhn H, Thomas M. The Weil Osteotomy: A seven year follow up. Fuss Und Sprunggelenk, 2006, 4(1): 72.
20.	Shibuya N, Jupiter DC, Plemmons BS, et al. Correction of hallux valgus deformity in association with underlying metatarsus adductus deformity. Foot Ankle Spec, 2017, 10(6): 538-542.
21.	Jung HG, Lee JS, Sun MY, et al. The effect proximal reverse chevron metatarsal osteotomy for metatarsus adductus on hallux valgus. Foot Ankle Surg, 2017, 23(S1): 131.
22.	Zhu Y. First metatarsophalangeal arthrodesis for treatment of hallux valgus with severe metatarsus adductus deformity. AOFAS Annual Meeting, 2016: 1.

1. 王正义. 足踝外科学. 北京: 人民卫生出版社, 2014: 117-119.
2. Ferrari J, Malone-Lee J. A radiographic study of the relationship between metatarsus adductus and hallux valgus. J Foot Ankle Surg, 2003, 42(1): 9-14.
3. La Reaux RL, Lee BR. Metatarsus adductus and hallux abducto valgus: their correlation. J Foot Surg, 1987, 26(4): 304-308.
4. Kilmartin TE, Barrington RL, Wallace WA. Metatarsus primus varus. A statistical study. J Bone Joint Surg (Br), 1991, 73(6): 937-940.
5. Chen L, Wang C, Wang X, et al. A reappraisal of the relationship between metatarsus adductus and hallux valgus. Chin Med J (Engl), 2014, 127(11): 2067-2072.
6. Larholt J, Kilmartin TE. Rotational scarf and akin osteotomy for correction of hallux valgus associated with metatarsus adductus. Foot Ankle Int, 2010, 31(3): 220-228.
7. Yu GV, DiNapoli DR. Surgical management of hallux abductovalgus with concomitant metararsus adductus//McGlamry ED, ed. Reconstructive surgery of the foot and leg: update’89. Tucker (GA): Podiatry Institute, 1989: 262-268.
8. Dawoodi AI, Perera A. Reliability of metatarsus adductus angle and correlation with hallux valgus. Foot Ankle Surg, 2012, 18(3): 180-186.
9. Roles NC, Maudsley RH. Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment. J Bone Joint Surg (Br), 1972, 54(3): 499-508.
10. Aiyer AA, Shariff R, Ying L, et al. Prevalence of metatarsus adductus in patients undergoing hallux valgus surgery. Foot Ankle Int, 2014, 35(12): 1292-1297.
11. 陈立, 马昕, 王旭, 等. 合并跖内收畸形对踇翻治疗效果的影响. 足踝外科电子杂志, 2015, 2(1): 26-29.
12. Schneider W. Distal soft tissue procedure in hallux valgus surgery:biomechanical background and technique. Int Orthop, 2013, 37(9): 1669-1675.
13. 黄加张, 马昕, 王旭, 等. Akin 截骨术在拇外翻手术应用的探讨. 中国骨与关节外科, 2012, 5(2): 150-153.
14. Malviya A, Makwana N, Laing P. Scarf osteotomy for hallux valgus—is an Akin osteotomy necessary? Foot Ankle Surg, 2007, 13(4): 177-181.
15. Aiyer A, Shub J, Shariff R, et al. Radiographic recurrence of deformity after hallux valgus surgery in patients with metatarsus adductus. Foot Ankle Int, 2015, 37(2): 165-171.
16. Shima H, Yasuda T, Mori K, et al. Surgical procedures and outcomes in the treatment of hallux valgus with metatarsus adductus. Foot Ankle Surg, 2017, 23(S1): 79.
17. Tóth K, Huszanyik I, Kellermann P, et al. The effect of first ray shortening in the development of metatarsalgia in the second through fourth rays after metatarsal osteotomy. Foot Ankle Int, 2007, 28(1): 61-63.
18. Sharma J, Aydogan U. Algorithm for severe hallux valgus associated with metatarsus adductus. Foot Ankle Int, 2015, 36(12): 1499-1503.
19. Kuhn H, Thomas M. The Weil Osteotomy: A seven year follow up. Fuss Und Sprunggelenk, 2006, 4(1): 72.
20. Shibuya N, Jupiter DC, Plemmons BS, et al. Correction of hallux valgus deformity in association with underlying metatarsus adductus deformity. Foot Ankle Spec, 2017, 10(6): 538-542.
21. Jung HG, Lee JS, Sun MY, et al. The effect proximal reverse chevron metatarsal osteotomy for metatarsus adductus on hallux valgus. Foot Ankle Surg, 2017, 23(S1): 131.
22. Zhu Y. First metatarsophalangeal arthrodesis for treatment of hallux valgus with severe metatarsus adductus deformity. AOFAS Annual Meeting, 2016: 1.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures in treatment of hallux valgus associated with mild to moderate metatarsus adductus

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