title: The Scarf Osteotomy with Minimally Invasive Lateral Release for Treatment of Hallux Valgus Deformity: Intermediate and Long-Term Results.
abstract: BACKGROUND
  Little is known about the long-term results of surgical correction of hallux valgus deformity, in particular, the recurrence rate and factors leading to recurrence.
  
  
  METHODS
  Of one hundred and eight patients (115 feet) who underwent a Scarf osteotomy, ninety-three patients (ninety-three feet) were examined at an average duration of follow-up of 124 months. Clinical examination before surgery and at the time of final follow-up included an evaluation of range of motion, pain as measured with a visual analog scale, and American Orthopaedic Foot & Ankle Society (AOFAS) scores. The Foot and Ankle Outcome Score (FAOS) was also assessed postoperatively. Radiographic data were evaluated preoperatively, at six weeks postoperatively, and at the time of final follow-up. Additional radiographic data were available for seventy-nine patients of the same patient cohort at an average of twenty-seven months postoperatively.
  
  
  RESULTS
  The median overall AOFAS score improved from 57 points preoperatively to 95 points at the time of final follow-up. All radiographic measurements (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], and sesamoid bone position) showed significant (p < 0.05) improvement at the time of final follow-up compared with preoperatively. The rate of recurrence (an HVA of ≥20°) at the time of final follow-up was 30%. We were unable to determine if recurrence resulted in functional impairment or consequences for quality of life.
  
  
  CONCLUSIONS
  The recurrence rate after ten years was 30%, and a higher final HVA resulted in higher pain levels. The limitations imposed by nonvalidated outcome measures precluded conclusions about the influence of HVA on function or quality of life.
authors.affiliation: Orthopedic Hospital Wien Speising, Speisinger Strasse 109, 1130 Vienna, Austria. E-mail address for P. Bock: dr.bock@gmx.at.
authors.forename: Peter
authors.initials: P
authors.lastname: Bock
authors.affiliation: Danube Hospital Vienna, Langobardenstrasse 122, 1220 Vienna, Austria.
authors.forename: Rainer
authors.initials: R
authors.lastname: Kluger
authors.affiliation: Fusszentrum Wien, Alserstrasse 43/8, 1080 Vienna, Austria.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kristen
authors.affiliation: Department of Clinical Biometrics, Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria.
authors.forename: Martina
authors.initials: M
authors.lastname: Mittlböck
authors.affiliation: Department of Orthopaedics, University Clinics Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schuh
authors.affiliation: Orthopedic Hospital Wien Speising, Speisinger Strasse 109, 1130 Vienna, Austria. E-mail address for P. Bock: dr.bock@gmx.at.
authors.forename: Hans-Joerg
authors.initials: HJ
authors.lastname: Trnka
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D056888:Patient Positioning / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors