Purpose: The growing use of foot surgery includes many innovating techniques which require adequate evaluation. To facilitate evaluation, the Association Française de Chirurgie du Pied (AFCP) elaborated a computer program for acquisition of clinical and radiological data on foot surgery. The data collected were centralised and analysed to assess surgical procedures.

Material and methods: Clinically. Signs of forefoot disorders were reviewed and classed by surgeons with extensive experience in forefoot surgery. Signs were classed by topic then formulated for the computer display to facilitate input during consultations. A system of profiles was designed to limit the data input filed and shorten input time. The program includes an automatic calculation of the Kitaoka forefoot score.

Radiologically: The system includes a tool for analysing radiographs using a vectorial drawing software integrated in the database. This system uses remarkable landmarks chosen by clicking on the radiographs: angles and lengths for preoperative planning are calculated automatically. These values are automatically integrated into the database and can be retrieved for file studies.

Operation report: Procedures performed on the forefoot are presented in picture form with clinical data. A profiles system is used to choose the items for input and reduce entry time.

Printout: Printouts can be made to include in the patient’s files.

Exploitation: Data can be exported for processing with another programme. This function was tested with a dissertation written on Weil osteotomies.

Conclusion: This freely distributed software is a first step toward a computer evaluation system for foot surgery. Our hope is that sufficient data can be collected to validate the reliability of our surgical techniques.

Purpose: We are often tempted to set aside (forget?) a certain number of cases we treated during our “learning curve”. We decided to review our first 56 cases of Scarf osteotomies five years after surgery. We detailed outcome, failures, and current modifications of the surgical technique.

Material and methods: End 1991 beginning 1992, we performed Scarf osteotomy on the first metatarsal in 56 feet for correction of hallux valgus in 33 patients aged 22 to 73 yeas (mean 49.7 years). Metatarso-phalangeal deviation of the first row was 20° to 70° (mean 38.5°) associated with metatarus varus from 12° to 24° (mean 16.6°). There were seven types of hallus valgus. Sesamoid deviation was classed in five categories. There were 20, 15 and 19 Greek, square and Egyptian feet respectively. Associated procedures included 26 osteotomies of the first phalanx of the great toe: twelve for angulation, ten for shortening, and six for angulation and shortening. For the other rows, there were five Gauthier osteotomies of the neck of the second metatarsal for overload syndrome of the second row and one Gauthier osteotomy of the second and third metatarsals for metatarso-phalangeal dislocation.

Results: The patient-assessed subjective result deteriorated with time: excellent 36 (64.2%), good 18 (32.1%), fair 2 (3.7%) at one year and excellent 32 (57.2%), good 15 (26.7%), fair 7 (12.5%), mediocre 1 (2.6%) at five years. Objective results for deformations were: postoperative metatarso-phalangeal angle of the first row 10° to 35° (mean 19°) and metatarsus varus 10° to 18° (mean 11.3°). The morphological result was practically acquired at one year, there was little further accentuation of the deformation with time. There was a clear improvement of the sesamoid position. These positive results cannot mask seven cases with angles of 30° and three with 35°. There was no case of hallux varus in this series. There were two “failures” requiring revision, one for recurrent and bothersome bone deformation and the other for metatarsalgia that developed only after correction of the hallux valgus.

Discussion, conclusion: This review disclosed two problems: insufficient correction and the development of postoperative metatarsalgia. The defective corrections were attributed to insufficient translation in the early cases and to the osteotomy which did not lower (or even raise) the metatarsal head. We have changed the osteotomy line in order to widen the translation surface and also to lower more the metatarsal head.