Modified chevron osteotomy vs. scarf osteotomy in correction of hallux valgus deformities

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
84 patients (109 feet) with hallux valgus deformity were randomized to receive either modified chevron osteotomy (with an extended plantar limb) or scarf osteotomy to determine their comparative efficacy with regards to deformity correction, functional improvement, and patient satisfaction. Outcomes were followed-up at one year postoperatively. Findings indicated a Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
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Why was this study needed now?
Hallux valgus deformities are often corrected using osteotomy procedures, although an optimal osteotomy technique has yet to be determined due to the various advantages and limitations of each method. The extended plantar limb chevron osteotomy technique was introduced as a modified version of the traditional distal chevron osteotomy method in response to its limitations such as instability and possible osteonecrosis. Alternatively, the scarf osteotomy method has gained recent popularity. The present study was conducted to comparatively address the efficacy of these two osteotomies.
What was the principal research question?
In the treatment of hallux valgus deformities, what is the comparative efficacy of a modified chevron osteotomy and a scarf osteotomy on deformity correction, functional improvement, and patient satisfaction assessed at one year postoperatively?
Population: 84 patients (109 feet), at least 16 years of age, with a deformity in the hallux valgus characterized by an intermetatarsal angle of 10 to 21 degrees were included. Procedures were standardized and general anesthesia with a regional block and a thigh tourniquet were used in all cases. Weight-bearing on the heel in orthopaedic shoes was allowed immediately after the operation. Suture removal and hallux splint application were performed at 2 weeks postoperatively, and splint and orthopaedic shoe removal occurred at 6 weeks postoperatively. (Mean age: 50.7+/-14.1 years; 75F/9M)
Intervention: Scarf osteotomy group: patients received correction treatment using the scarf osteotomy technique.
Comparison: Modified chevron osteotomy group: patients received a modified procedure of the traditional distal chevron osteotomy technique where the plantar limb is elongated as a result of a more horizontal plantar cut.
Outcomes: Primary outcomes were radiographic analysis of the degree of correction achieved based on the intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and the tibial sesamoid position; the Manchester-Oxford Foot Questionnaire (MOxFQ); and patient satisfaction with the operative procedure.
Methods: RCT; patient-blinded
Time: Outcomes were assessed at 6 weeks and 1 year postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.