title: The combined reverse scarf and opening wedge osteotomy of the proximal phalanx for the treatment of iatrogenic hallux varus.
abstract: BACKGROUND
  [Corrected] Hallux varus is a complication of hallux valgus surgery. Historically the standard treatment has been to arthrodese the first metatarso-phalangeal (MTP) joint. More recently other options have come to light, including reverse osteotomies and tendon-transfer procedures.
  
  
  OBJECTIVE
  This paper presents a small retrospective audit of patients who developed hallux varus following the combined rotation scarf and Akin osteotomy for hallux valgus, and their subsequent treatment with a stepwise approach of soft tissue release and ultimately reverse scarf osteotomy and opening wedge osteotomy of the proximal phalanx.
  
  
  METHODS
  Five patients attended for a retrospective audit including reasons for revision surgery, review of intermetatarsal (IM) and first metatarso-phalangeal joint (MTPA) angles, AOFAS scores and patient satisfaction.
  
  
  RESULTS
  At a mean follow up of 38 months, mean IM angle and MTP joint angle improved from 5 to 9° and -10° to 11° respectively. Mean first MTP joint dorsiflexion and plantarflexion was 26° and 19° respectively. One patient was completely satisfied and four were satisfied with reservations with their surgical outcome and 100% felt they were better off as a result of their surgery.
  
  
  CONCLUSIONS
  The stepwise approach to the reverse scarf and opening wedge osteotomy of the proximal phalanx for iatrogenic hallux varus is an alternative to first MTP joint arthrodesis for those with a viable joint.
authors.affiliation: Department Podiatric Surgery, Ilkeston Hospital, Heanor Road, Ilkeston DE7 8LN, United Kingdom. ewankannegieter@me.com
authors.forename: E
authors.initials: E
authors.lastname: Kannegieter
authors.forename: T E
authors.initials: TE
authors.lastname: Kilmartin
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000601:surgery*; D050488:Hallux Varus / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013709:Tendon Transfer / Q000379:methods*; D050277:Toe Phalanges / Q000601:surgery*; D016896:Treatment Outcome