title: Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized controlled trial.
abstract: BACKGROUND
  Chevron osteotomy is a widely accepted osteotomy for correction of hallux valgus.(18) Algorithms were developed to overcome the limitations of distal osteotomies. Scarf osteotomy has become popular as a versatile procedure that should be able to correct most cases of acquired hallux valgus. The purpose of this study was to evaluate whether patients with moderate or severe hallux valgus have better correction with a scarf osteotomy as compared to chevron osteotomy.
  
  
  METHODS
  After informed consent, 136 feet in 115 patients were randomized to 66 scarf and 70 chevron osteotomies. Deformities of patients were classified as mild, moderate and severe according to IMA, and both groups were compared with independent t-tests. The results were measured using radiographic HVA, IMA and DMAA measurements.
  
  
  RESULTS
  There were no statistical differences in HVA, IMA and DMAA between scarf and chevron osteotomy in mild to moderate hallux valgus. In severe hallux valgus, chevron osteotomy corrected HVA better than scarf osteotomy, although this group consisted of twelve patients only. Five patients in the chevron group and seven in the scarf group developed recurrent subluxation of the metatarsophalangeal joint.
  
  
  CONCLUSIONS
  In patients with moderate and severe hallux valgus, the results of chevron osteotomy were at least as effective as a scarf osteotomy. Recurrent subluxation of the first metatatarsophalangeal joint was the main cause for insufficient correction. We favor the chevron osteotomy because it is less invasive, without sacrificing correction of HVA and IMA.
authors.affiliation: Ziekenhuis Bronovo, Bronovolaan 5, 2597 AX Den Haag, The Netherlands. axeldeenik@zonnet.nl
authors.forename: Axel
authors.initials: A
authors.lastname: Deenik
authors.forename: Henk
authors.initials: H
authors.lastname: van Mameren
authors.forename: Enrico
authors.initials: E
authors.lastname: de Visser
authors.forename: Maarten
authors.initials: M
authors.lastname: de Waal Malefijt
authors.forename: Frits
authors.initials: F
authors.lastname: Draijer
authors.forename: Rob
authors.initials: R
authors.lastname: de Bie
mesh_terms: D006215:Hallux Valgus / Q000145:classification / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome