The combined reverse scarf and opening wedge osteotomy of the proximal phalanx for the treatment of iatrogenic hallux varus.

Abstract

BACKGROUND:

[Corrected] Hallux varus is a complication of hallux valgus surgery. Historically the standard treatment has been to arthrodese the first metatarso-phalangeal (MTP) joint. More recently other options have come to light, including reverse osteotomies and tendon-transfer procedures.

OBJECTIVES:

This paper presents a small retrospective audit of patients who developed hallux varus following the combined rotation scarf and Akin osteotomy for hallux valgus, and their subsequent treatment with a stepwise approach of soft tissue release and ultimately reverse scarf osteotomy and opening wedge osteotomy of the proximal phalanx.

METHOD:

Five patients attended for a retrospective audit including reasons for revision surgery, review of intermetatarsal (IM) and first metatarso-phalangeal joint (MTPA) angles, AOFAS scores and patient satisfaction.

RESULTS:

At a mean follow up of 38 months, mean IM angle and MTP joint angle improved from 5 to 9° and -10° to 11° respectively. Mean first MTP joint dorsiflexion and plantarflexion was 26° and 19° respectively. One patient was completely satisfied and four were satisfied with reservations with their surgical outcome and 100% felt they were better off as a result of their surgery.

CONCLUSION:

The stepwise approach to the reverse scarf and opening wedge osteotomy of the proximal phalanx for iatrogenic hallux varus is an alternative to first MTP joint arthrodesis for those with a viable joint.

• Authors: E Kannegieter, T E Kilmartin
• Journal: Foot (Edinburgh, Scotland) (Foot (Edinb)) Vol. 21 Issue 2 Pg. 88-91 (Jun 2011) ISSN: 1532-2963 [Electronic] Scotland
• PMID: 21316213 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 Elsevier Ltd. All rights reserved.

Topics

• Female
• Follow-Up Studies
• Hallux Valgus (surgery)
• Hallux Varus (etiology, physiopathology, surgery)
• Humans
• Iatrogenic Disease
• Male
• Metatarsophalangeal Joint (surgery)
• Middle Aged
• Osteotomy (adverse effects, methods)
• Patient Satisfaction
• Postoperative Complications (etiology, surgery)
• Range of Motion, Articular
• Retrospective Studies
• Tendon Transfer (methods)
• Toe Phalanges (surgery)
• Treatment Outcome