Complex Regional Pain Syndrome (CRPS) is regarded as an uncommon clinical complication to orthopaedic surgery. Few have looked into its prevalence in foot and ankle surgery. This is a retrospective cohort study of all patients undergoing foot and ankle surgery, operated on by the foot and ankle team in our department in 2009. The objectives of this study was to determine the prevalence CRPS in these patients post-operatively and to examine the associated factors. 17 patients from 390 (4.4%) were identified as meeting the IASP (International Association for the Study of Pain) criteria for the diagnosis of CRPS. Of these, the majority were female (n = 14, 82.4%) and the average age was 47.2 (SD 9.7). All were elective patients. The majority involved operating on the forefoot (n = 9, 52.9%), followed by the hindfoot and ankle (3 cases each, 17.6%). Most of these patients had new onset CRPS (n = 12, 70.6%), with no previous history of the condition. 3 patients (17.6%) had documented nerve damage and therefore suffered from CRPS Type 2. Blood results were available for 14 (82.4%) patients at a minimum of 3 months post-operatively, and none had elevated inflammatory markers. 5 of the patients (29.4%) were smokers and 8 (47.1%) had a pre-existing diagnosis of anxiety or depression. At present, based on our findings, we recommend that middle-aged women, with a history of anxiety or depression, undergoing elective foot surgery be specifically counselled on the risk of developing CRPS at consenting. We recommend similar studies to be undertaken in other West of Scotland orthopaedic units.
Subjective and objective review of our early experience with scarf osteotomy for correction of Hallux valgus
Scarf joint is a technique used by carpenters to increase the size of entrance by longitudinally joining beams of timbers. Scarf osteotomy of the first metatarsal is a ‘Z’-osteotomy with inherent stability. The convalescence is short and complications of avascular necrosis and non-union are rarely reported. The combination of soft tissue procedure with the osteotomy consistently gives good correction of hallux valgus.
The records, radiographs were reviewed and the subjective assessment by telephone interview. Forty-one patients had a scarf procedure but only 31 patients (37 scarf procedures) could be contacted by telephone. All patients were females with a mean age of 44.6(16–76) years. Mean follow-up was 14 months(12 to 18 months). The results were reviewed using the guideline recommended by the Research Committee of American Orthopaedic Foot and Ankle Society. Mean preoperative hallux valgus angle (HVA) was 30.4°(20–48°) and the postoperative HVA was 14.6°(9–22°). The mean pre-operative intermetatarsal angle (IMA) was 4.1°(10–22°) and postoperatively was 8.4°(5–12°). There was significant correction of the tibia sesamoid position (p=0.001). There was no avascular necrosis or non-union. Eighty-eight percent of patients were satisfied; two patients had infection and two stiff MTP joints.
Scarf osteotomy gives very good correction of hallux valgus and tibia sesamoid position. Patient satisfaction was good with a low complication rate, the fixation after the osteotomy was very stable and no post-operative splint was required.
