Scarf osteotomy is widely used as a surgical treatment for hallux valgus. It is a versatile osteotomy, allowing shortening, depression or medial displacement of the capital fragment but it remains uncertain how stresses within the bone subsequently vary. The aim of this study was to design a computerised model to explore the effect on bone stress of changing the position of bony cuts for a scarf osteotomy.

A computerised image was constructed using finite element analysis. This utilises a mathematical technique to form element equations which represent the effect of applied force to the object appropriate to each finite element. Maximum bone stresses were then measured using different osteotomy variables. The osteotomy variables studied were the length of the longditudinal cut, apex of the distal cut to articular cartilage, resection level of the longditudinal cut and combinations of these variables. A saw bone model was used to test the findings of the study.

The results of this study show that lowering the longditudinal resection level and shortening via the distal cut beyond 6 mm will decrease bone stress. Additionally, raising the longditudinal resection level and shortening via the proximal cut caused an increase in bone stress. A saw bone model confirmed the findings of the study.

In conclusion, our experience is that finite element analysis is a very useful model in studying the bony stresses for a scarf osteotomy and assists in optimising the direction and angle of bony cuts used.

Introduction: Morton’s neuroma is a common cause of foot pain. For this study, we assessed the efficacy of a series of sonographically guided alcohol injections into the lesion.

Method: One hundred and one consecutive patients with Morton’s neuroma were included in this prospective series. An average of 4.1 treatments per person wee administered, and follow-up images were obtained at a mean of 21.1 months after the last treatment (range, 13–34 months).

Results: Technical success was 100%. Partial or total symptom improvement was reported by 94% of the patients, with 84% becoming totally pain-free. The median visual assessed pain score decreased from 8 before treatment to 0 after treatment (p< 0.001). Transitory increased local pain occurred in 17 cases (16.8%). There were no major complications. Thirty patients underwent sonography at 6 months after the last injection and showed a 30% decrease in the size of the neuroma.

Discussion and Conclusion: We conclude that alcohol injection of Morton’s neuroma has a high success rate and is well tolerated. The success rate is acceptable at 84% whilst being associated with a low morbidity. The treatment avoids surgery and allows continued mobility with patients being able to weight bear and perform their usual activities of daily living. We advocate reserving surgical management for non-responders.