Scarf osteotomy or Lapidus procedure in the treatment of severe Hallux valgus. Does the patient have a choice?

H. Yakob, S. Sirikonda, C. Walker

Background: There are a variety of accepted surgical techniques to treat severe Hallux Valgus. This study looked at separate case series between two surgeons preferring different techniques. The correction of hallux valgus angle (HVA), intermetatarsal angle (IMA) and scores of the validate Manchester-Oxford foot questionnaire (MOxFQ) were compared between the scarf osteotomy (Group A) and the Lapidus procedure (Group B).

Methods: A retrospective cohort study was conducted between September 2013 and August 2015. Patients were identified through the hospital database who had a Scarf osteotomy (n=21) and Lapidus procedure (n=17). We defined severe HV as having HVA >40° and IMA >17°. Only patients meeting this criteria were included. In Group A the surgeon adopted a more extreme osteotomy by shifting the first metatarsal head by greater than the 50% of its width. In Group B the method of fixation was with a medially placed plate plus an additional compression screw. Post-operative radiological measurements were taken six weeks after surgery. MOxFQ scores were collected prior and at six months after surgery.

Results: The mean correction for HVA in Groups A and B were 29.68° (25.94°-33.42°) and 29.78° (25.12°-34.43°) respectively. For IMA the values were 10.38° (8.63°-12.13°) and 11.25° (9.91°-12.59°). There was no significant difference in HVA (p=0.98,CI=-6.20-6.01) or IMA (p=0.46,CI=-3.24-1.49) correction between the groups. There was an overall improvement in MOxFQ scores six months after surgery for both groups and the difference between them was not significant (p=0.08).

Conclusion: The post-operative correction of HVA and IMA was similar between the two surgical techniques. At six months after surgery both groups reported an improvement in symptoms based the MOxFQ scores which was no different between the two groups. Our study showed that performing a more extreme scarf osteotomy can produce similar results to the Lapidus procedure in correction of severe HV.