Forefoot Width Correction in Hallux Valgus after Rotational Scarf Osteotomy

Abstract

Category: Bunion; Other Introduction/Purpose: Hallux valgus is a common deformity represented by a wider forefoot, associated with pain, shoe restrictions, and cosmetic problems. The goal of hallux valgus surgery is to achieve a painless foot by realigning the deviated first ray, thereby reducing friction between bony prominences and regular footwear. There is limited evidence on the effect of osseous procedures after hallux valgus surgery on the width of the resulting foot. Methods: We retrospectively performed measurements of forefoot width (bony and soft tissues) on AP standard x-ray from the first metatarsal head to the fifth metatarsal head, pre-and postoperatively at 3 months. Results: Thirty patients met the inclusion criteria, with a total of 42 feet. Radiographically, the preoperative mean 1-5 metatarsal bony width was 89.30mm SD (5.8) to 80.42mm postoperative SD (3.5). Regarding the soft tissue width, the preoperative average was 102.45mm SD (6.4) to 98.3mm postoperative SD (5.1). The ICC between both observers was 'excellent' in most measures (range, 0.884-0.973). Values obtained had a significance of p<0.001. Size effect was considered medium-high, with 0.87 power. Conclusion: We report an objective reduction in the forefoot width, both bony and soft tissue, by means of 8.88mm (10%) and 4.12mm (4.1%), respectively after scarf akin osteotomy. These results are represented by better shoe comfort and aesthetics.