Scarf versus Chevron Osteotomy in Hallux Valgus: A Randomized Controlled Trial in 96 Patients

Abstract

Background: The degree of correction of hallux valgus deformity using a distal chevron osteotomy is reported as limited. The scarf osteotomy is reported to correct large intermetatarsal angles (IMA). The purpose of this study was to evaluate if one technique gave greater correction of the IMA and hallux valgus angle (HVA) than the other. Methods: After informed consent, 96 feet in 83 patients were randomized into two treatment groups (49 scarf and 47 chevron osteotomies). The results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Valgus Scale and radiographic HVA and IMA measurements. Results: At 27 (range 23–31) months followup both groups improved. The AOFAS score in the chevron group improved from 48 to 89 points and in the scarf group from 47 to 91 points. In the chevron group the HVA corrected from 30 to 17 degrees, and in the scarf group the HVA corrected from 29 to 18 degrees. In both groups, the IMA was corrected from 13 to 10 degrees. The differences were not statistically significant. Three patients in the chevron group developed a partial metatarsal head necrosis. In the scarf group, four patients developed grade 1 complex regional pain syndrome compared to one patient in the chevron group. Conclusions: No differences of statistical significance could be measured between the two groups with respect to the AOFAS score, HVA, and IMA. Although both groups showed good to excellent results, we favor the chevron osteotomy because the procedure is technically less demanding.

Keywords

Chevron Hallux Valgus Osteotomy Scarf Surgery

Get full access to this article

View all access options for this article.

References

Barouk

: Scarf osteotomy for hallux valgus correction. Local anatomy, surgical technique, and combination with other forefoot procedures. Foot Ankle Clin. 5:525–528, 2000.

Coetzee

: Scarf osteotomy for hallux valgus repair: The dark side. Foot Ankle Int. 24:29–33, 2003.

Coughlin

: Hallux valgus. Instr. Course Lect. 46:357–391, 1997.

Crosby

Bozarth

: Fixation comparison for chevron osteotomies. Foot Ankle Int. 19:41–43, 1998.

Dereymaeker

: Scarf osteotomy for correction of hallux valgus. Surgical technique and results as compared to distal chevron osteotomy. Foot Ankle Clin. 5:513–524, 2000.

Edwards

: Avascular necrosis of the first metatarsal head. Foot Ankle Clin, 10:117–127, 2005.

Hattrup

Johnson

: Subjective results of hallux rigidus following treatment with cheilectomy. Clin. Orthop. 226:182–191, 1988.

Kitaoka

Alexander

Adelaar

: Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 15:349–353, 1994.

Mann

: Decision-making in bunion surgery. Instr. Course Lect. 39:3–13, 1990.

10.

Meier

Kenzora

: The risks and benefits of distal first metatarsal osteotomies. Foot Ankle 6:7–17, 1985.

11.

Miller

: Distal first metatarsal displacement osteotomy. Its place in the schema of bunion surgery. J. Bone Joint Surg. 56-A:923–931, 1974.

12.

Perugia

Basile

Gensini

Stopponi

Simeonibus

: The scarf osteotomy for severe hallux valgus. Int. Orthop. 27:103–106, 2003.

13.

Resch

Stenstrom

Gustafson

: Circulatory disturbance of the first metatarsal head after chevron osteotomy as shown by bone scintigraphy. Foot Ankle 13:137–142, 1992.

14.

Schneider

Csepan

Knahr

: Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery. J. Bone Joint Surg 85-A:494–499, 2003.

15.

Schoen

Zygmunt

Gudas

: Z-bunionectomy: Retrospective long-term study. J. Foot Ankle Surg. 35:312–317, 1996.

16.

Smith

Reynolds

Stewart

: Hallux valgus assessment: Report of research committee of American Orthopaedic Foot and Ankle Society. Foot Ankle. 5:92–103, 1984.

17.

Trnka

Zembsch

Easley

: The chevron osteotomy for correction of hallux valgus. Comparison of findings after two and five years of follow-up. J. Bone Joint Surg. 82-A:1373–1378, 2000.