SURGICAL TREATMENT OF HALLUX VALGUS: A CLINICAL PROSPECTIVE RANDOMIZED STUDY COMPARING LINEAR DISTAL METATARSAL OSTEOTOMY WITH SCARF OSTEOTOMY.

Abstract

OBJECTIVE OF THE STUDY: Metatarsal osteotomies are common procedures for correction of hallux valgus. The aim of this study is to compare linear distal metatarsal osteotomy (LDMO) with SCARF osteotomy a clinical prospective randomised study.

METHODS: Forty patients affected by bilateral hallux valgus similar in both sides regarding clinical and radiographic assessment were included. X-rays, AOFAS, Maryland Foot Score (MFS) were considered before surgery up to 4 years follow-up. All patients were operated bilaterally, and received SCARF osteotomy in one side, and in the other LDMO performed through a 1 cm skin incision under the direct view control. Duration of surgery was recorded. Postoperative care was similar in both groups and consisted of gauze bondage and weight bearing with talus shoes for 4 weeks.

RESULTS: No statistical differences were observed in preoperative HVA, IMA, PASA in both groups. Average surgical time was 17 minutes in SCARF and 3 minutes in LDMO (p< 0.0005). No complications were observed in the series, with no wound dehiscence. All osteotomies healed. At 4 year follow up, no statistical differences were observed in HVA, IMA, PASA comparing SCARF with LDMO. Average AOFAS score was 87±12 in SCARF and 89±10 in LDMO (p=0.07), and MFS was 86±7 in SCARF and 90±3 in SERI (p=0.08).

CONCLUSION: Both SCARF and LDMO techniques resulted effective in the correction of hallux valgus, however SERI, a minimally invasive technique, performed with a shorter skin incision, more rapid surgical time, fixed with a less expensive device (one kirshner wire), resulted in a better clinical outcome.