A randomized comparison of the proximal crescentic osteotomy and rotational scarf osteotomy in the treatment of hallux valgus

Abstract

Objectives: The aim of this study was to compare clinical and radiological results of proximal crescentic osteotomy (PCO) and rotational scarf osteotomy performed in the treatment of hallux valgus. Methods: A total of 57 consecutive patients (60 feet) with symptomatic hallux valgus deformity were randomly assigned to one of two groups. The PCO group consisted of 22 women and 5 men (30 feet) and the mean age was 43(±14.5) years. The scarf group consisted of 23 women and 7 men (30 feet) and the mean age was 40.9(±12.6) years. Outcomes were assessed by using of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS). Weight bearing X-rays were used for radiological evaluation. Results: The mean AOFAS scores improved from 42(±16.2) to 66.7(±13.4) points in PCO group and from 36.2(±16.1) to 73.2(±13.5) points in scarf group. The mean pain score improved from 6.3(±1.3) to 2.4(±2) in PCO group and from 6.5(±1.9) to 2.5(±1.3) in scarf group. The mean hallux valgus angle (HVA) decreased from 38.1°(±7.1) preoperatively to 23.8°(±8.5) at postoperative first year in PCO group, and from 36.1°(±7.5) preoperatively to 22.2°(±7.5) at postoperative first year in scarf group. The mean intermetatarsal angle (IMA) decreased from 17.3°(±3.8) preoperatively to 11.8°(±3.3) at postoperative first year in PCO group, and from 16.2°(±2.6) preoperatively to 9.3°(±2.4) at postoperative first year in scarf group.When all the patients were assessed together, the relations between preoperative DMAA values and postoperative first year HVA (r = 0,327) and IMA (r = 0,399) values were positive but had low significance. The HVA and IMA values were increased in both groups at the end of the first year when compared to the postoperative sixth week values (p < 0.01 for both groups for both values). Conclusion: The PCO and the rotational scarf osteotomy in the treatment of hallux valgus deformity provides a satisfactory correction. The clinical and radiological results of both methods are similar. Especially in patients with high preoperative DMAA, an increase in the HVA and the IMA values may occur in the first postoperative year when compared to the postoperative sixth week values. Level of evidence: Level II, therapeutic study. Keywords: Hallux valgus, Scarf osteotomy, Proximal crescentic osteotomy, Surgical treatment, Foot