Scarf osteotomy for correction of hallux abducto valgus increases patient satisfaction lowers complications

The study by Sharon clee et al reviews the patient experience and outcomes in five podiatric surgery centres using the scarf diaphyseal osteotomy.

The authors found that - "The scarf osteotomy (with or without an Akin phalangeal osteotomy) consistently showed high patient satisfaction with low complication rates using Patient Satisfaction Questionnaire 10 (PSQ-10) and this information can be used as part of the preoperative consenting process."

Corrective surgery for hallux abducto valgus (HAV) is one of the most performed elective procedures in foot and ankle practice. Numerous methods of surgical correction have been reported within the literature, with varying clinical and patient reported outcomes.

Patient reported outcome measures (PROMs) were captured using the Patient Satisfaction Questionnaire 10 (PSQ-10), part of the PASCOM-10 podiatric surgery audit tool. PROMs were collated across five hospital sites over a 10-year period.

The results of the study were -

• Of 1351 patients reported during the period, 1189 had complete retrospective data.

• The most common patient aim of surgery was 'no/less pain' reported in 70% of patients. 96.8% of patients reported their original foot complaint as 'better' or 'much better' after surgery.

• 92.8% of patients reported their expectations had been met with 96.6% reporting they would have surgery again under the same conditions.

• 98.5% of patients noted that the risks, complications, and expectations had been discussed prior to surgery.

• The most common complication was metatarsal fracture (4.6%).

Although the figures presented are mid-term results, the authors believe that the data gives a good indication of the outcomes and post-operative sequelae that may affect patients undergoing a scarf (with or without an Akin) osteotomy for HAV correction as performed by podiatric surgeons. This should enable a more informed consenting process with the patients in the future. The data suggests good outcomes for the procedure in a wide cohort of patients, across five podiatric centres, where much of the surgery is performed by non-consultant grades. This study has also highlighted the importance of inputting post-operative sequalae as they occur, rather than waiting until the final review, to capture a more accurate and comprehensive overview of any concerns raised by both patient and clinician. Patient expectations of surgery were often achieved in the centres studies which may be attributed to the pre operative work up of the patient. Further investigation into this correlation is suggested. 

Level of clinical evidence: IV (retrospective review).

Further reading:

Correction of hallux abducto valgus by scarf osteotomy. A ten-year retrospective multicentre review of patient reported outcomes shows high satisfaction rates with podiatric surgery

Sharon Clee, George Flanagan et al

Journal of Foot and Ankle Research (2022) 15:44

https://doi.org/10.1186/s13047-022-00546-3