Scarf osteotomy for hallux valgus correction: radiological and clinical analysis / Osteotomia de scarf para correção do hálux valgo:análise radiológica e clínica

ABSTRACT Objectives: This article aims to radiographically and clinically evaluate the results of the surgical correction of hallux valgus using the scarf technique. The pre- and postsurgical hallux valgus angles - metatarsophalangeal angle (MP), intermetatarsal angle (IM), and degree of dislocation of the sesamoids - were retrospectively evaluated, as well as their clinical parameters. Methods: 70 pre- and postoperative radiographs of patients undergoing surgical correction of hallux valgus by the scarf osteotomy technique were retrospectively evaluated. The American Orthopedic Foot And Ankle Society Score (AOFAS) was used for pre- and postoperative clinical evaluation. Results: There was a statistically significant improvement in the MP, IM, and sesamoid position, in addition to the clinical improvement verified by the AOFAS. Conclusion: Scarf osteotomy improves the MP and IM angles and correct the position of the sesamoid, as well as improve the AOFAS. Level of Evidence IV, Retrospective Comparative Study.

RESUMO Objetivos: Analisar radiograficamente e clinicamente os resultados da correção cirúrgica do hálux valgo pela técnica de Scarf, assim como os ângulos pré e pós-cirúrgico do hálux valgo - ângulo metatarsofalângico (MTF) e ângulo intermetatarsal (IM) -, grau de luxação dos sesamoides e parâmetros clínicos. Métodos: Foram avaliadas retrospectivamente 70 radiografias com carga pré e pós-operatórias dos pacientes submetidos à correção cirúrgica do hálux valgo pela técnica de osteotomia de Scarf. Para avaliação clínica pré e pós-operatória foi utilizado a escala da American Orthopaedic Foot And Ankle Society (AOFAS). Resultados: Foi observado melhora estatisticamente significativa dos ângulos MTF e IM e posição dos sesamoides, além de melhora clínica verificada pela escala AOFAS. Conclusão: A osteotomia de Scarf é capaz de melhorar os ângulos MTF e IM e corrigir a posição dos sesamoides, acompanhado da melhora da escala AOFAS. Nível de Evidência IV, Estudo Retrospectivo Comparativo.

Hallux valgus en el adulto: conceptos actuales y revisión del tema / Hallux valgus in the adult: current concepts and review

El hallux valgus, o juanete, es la desviación en valgo del primer ortejo con una desviación en varo del primer metatarsiano. El 90% de los pacientes son mujeres, siendo las limitaciones más frecuentes el dolor medial sobre la prominencia ósea, el dolor plantar bajo la cabeza de los metatarsianos y la aparición de ortejos en garra. El antecedente genético y el uso de calzados en punta son los factores asociados más importantes en el origen de este cuadro. La decisión de tratamiento está relacionada exclusivamente con la limitación que esta deformidad produce en el/la paciente. Es frecuente que pacientes que no acostumbran usar calzado ajustado nunca tengan síntomas, aunque tengan un hallux valgus grave. Por el contrario, personas que por su trabajo deben usar calzado formal/ajustado, pueden tener un juanete doloroso incluso con deformidades leves. Formas no quirúrgicas de tratamiento no corrigen el juanete. Las únicas maneras de aliviar los síntomas son utilizando zapatos anchos y/o plantillas en caso de metatarsalgia. La corrección quirúrgica se realiza mediante osteotomías, realineando la estructura ósea. Existen múltiples técnicas, las que se utilizan dependiendo de la severidad del cuadro y de la experiencia del cirujano. La cirugía tiene resultados satisfactorios en aproximadamente el 85% de los casos con alivio del dolor y de la deformidad como objetivos. El riesgo de complicaciones es del 15% aproximadamente, siendo las principales la recidiva de la deformidad, la presencia de osteosíntesis sintomática e infección superficial. El riesgo de recidiva aumenta en casos de deformidades graves, siendo la gran mayoría de las recidivas leves en magnitud y no siempre requieren cirugía.

Hallux valgus, or bunion, is a deformity of the big toe and a first metatarsal varus deviation. Most (90%) of patients are women, with bunion pain, metatarsalgia, and claw toes, being the most frequent complaints. The genetic background and use of pointed shoes are the most important factors responsible for this condition. The treatment decision is taken depending on the complaints due to this deformity. Patients that do not usually wear tight pointed shoes never have symptoms even in severe hallux valgus. On the other hand, people that wear formal or tight footwear at work, it can be very painful even with very mild bunion deformities. Non-surgical treatment does not correct the bunion. The only way to relieve symptoms is using wide shoes, and / or insoles in cases of metatarsalgia. Surgical correction is performed by osteotomy. There are multiple techniques, which are used depending on the severity of the deformity and the experience of the surgeon. Successful outcomes are obtained in 85% of patients. The complications risk is about 15%, with recurrence, the presence of osteosynthesis, and superficial infections, accounting for most of them. The recurrence risk increases if the deformity is severe, but most recurrences are mild and do not always require surgery.

Minimal incision osteotomy for tailor's bunion / 中国矫形外科杂志

[Objective] To retrospectively analyze the treatment of tailor's bunion with minimal incision osteotomy,and to investigate the indications and effects of this procedure.[Method]Thirty-seven patients(69 feet)underwent the procedure from July 2002 to August 2007.The axial and lateral films of all feet with loading were taken before and after operation.AOFAS were recorded and analyzed preoperatively and postoperatively.[Result]The forth intermetatarsal angle was 14.36??7.32? before operation and 9.36??2.92?after operation.The unguis aduncus angle of digitus quintus pedis was 20.44??7.36? before operation and 4.36??1.35?after operation.The forth reforming intermetatarsal angle was 10.36??.2.81? before operation and 7.83??2.37?after operation.The exstrophy angle of the fifth metatarsal was 5.46??1.70? before operation and 2.13??0.38?after operation.The score of AOFAS was 45.7?5.6 before operation and 85.3?5.1 after operation.[Conclusion]The treatment of tailor's bunion with minimal incision osteotomy is easy to operate and its therapeutic effect is convincing.