Goals of Study

• Investigate the effect of the Scarf Procedure on the load characteristics of the forefoot using an Emed gait analysis system
• Evaluate the postoperative radiographic changes following Scarf osteotomy
• Evaluate the preoperative and postoperative 1st MTP range of motion

Materials & Methods

• Prospectively enrolled 30 patients with unilateral or bilateral hallux valgus from June 2006 - December 2006
• 46 feet with Scarf or Scarf Akin were evaluated
• Three surgeons within one institution performed the procedures.
• Exclusion criteria:
  • Concomitant forefoot pathology (hammertoes, clawtoes, and metatarsalgia) requiring concomitant surgery.
  • Patients with excessive first ray instability requiring 1st metatarsal-cuneiform fusion.

• Lenticular capsulorraphy
  
  
  
• Intra-articular sesamoid release
     
  
  
• Osteotomy guide
  
  
  
• Screw fixation
  
  
  
• Capsular repair
  
  
  
• Subcuticular closure
  
  
  
• Bulky compressive bandage post-operative
  
• One week post-operative
  • Bathing
  • Return to closed athletic shoes
  • Begin Physical Therapy
  
  
  
• 6-8 weeks post op
  • Return to all activities to tolerance
  • Return to all shoes to tolerance
  
  
  

Results

• Average age of the patients 37.8 years (14-76 years)
• Average follow-up time was 9.7 months (8-13months)
• 20 of the 30 patients(28/46 feet) required an Akin osteotomy in addition to the Scarf procedure
• Improvement of AOFAS score from
  • 65.7 to 86.3
• ACFAS 1st ray score improved from
  • 63.2 to 86.8
• The Intermetatarsal angle:
  • 14.3° pre-operatively
  • 9.5° post-operatively
   
• The hallux valgus angle:
  • 25.9° pre-operatively
  • 10.2° post-operatively
• 1st metatarsal declination angle:
  • 38.7° pre-operatively
  • 20.9° post-operatively
• 1st metatarsal phalangeal joint range of motion:
  • 64.5°- 11.3°pre-operatively
  • 68.7°- 11.3°post-operatively
   
• 2.6 weeks to return to work
• 3.1 weeks return to activities of daily living
  
  

  TABLE
  Clinical and Radiographic Results
  Clinical Parameters	Preoperative	Follow up
  AOFAS score	65.6	86.3
  ACFAS score	63.2	86.8
  Hallux Dorsiflexion	64.5	68.7
  Hallux Plantarflexion	11.3	11.3
  Hallux Valgus Angle	25.9	10.2
  Intermetatarsal Angle	14.3	9.5
  1st Met Declination Angle	38.7	20.9

  
  
  Pre Op
  
  
  Post Op
  
• Pedobarographic analysis showed medialization of peak plantar pressure following surgery
• Peak plantar pressure
  • Increased under the hallux and first metatarsal
  • Decreased under the 2nd, 3rd, 4th, and 5th metatarsals
  
• Two patients (2/46 feet) developed a stress fracture postoperatively which was treated with prolonged protection in a stiff soled shoe and healed uneventfully
• No other adverse events were noted.

Discussion

• These early results reinforce our belief that restoration of first ray peak pressure to physiologic loading is the key factor in restoring normal forefoot mechanics which lead to providing postoperative pain reliefsdf
• Early functional physical therapy, emphasizing plantarflexion, is critical to regaining proper plantarflexion strength of the hallux, which is crucial to reduce transfer pressures,initially described by Holmes
• Further investigation is needed to determine if the restoration of 1st ray plantarflexion is more important than the restoration of radiographic parameters in correcting forefoot load.

Weil Foot & Ankle Institute
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Email : info@weil4feet.com
Website : www.weil4feet.com