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Treatment of postoperative hallux varus by reverse scarf osteotomy

Published in N°274 - May 2018
Article viewed 309 times

Treatment of postoperative hallux varus by reverse scarf osteotomy

By Christophe Piat, Taieb Raboudi in category TECHNIQUE
CHU Henri Mondor Créteil / Clinique Victor Hugo Paris, CHU Henri Mondor Créteil

Hallux varus is a well-known complication of bunion surgery that can occur regardless of the technique used, whether it be osteotomy or tendon transfer.
This is a cause of dissatisfaction for surgeons and patients alike. Long periods, even several years, may pass between the initial surgery and when the surgeon needs to reoperate.

Introduction

Hallux varus is a well-known complication of bunion surgery that can occur regardless of the technique used, whether it be osteotomy or tendon transfer.

This is a cause of dissatisfaction for surgeons and patients alike. Long periods, even several years, may pass between the initial surgery and when the surgeon needs to reoperate.

A hallux varus may be tolerated but it is most often resented as a deformation; issues may arise with footwear and even when walking barefoot (Fig. 1).

Figure 1 :  Bilateral hallux varus supported.

 

One will observe transfer metatarsalgia, medial nerve issues, different attitudes in handling the hallux, medial clinodactyly of lateral rays, and a decrease in the propulsive final step phase. In the longer term, adverse mechanical conditions lead to joint stiffness and even postoperative osteoarthritis in the medial compartment of the first metatarsophalangeal (MTP) joint.

Most studies report a rate between 1% and 5%; however, some studies have described rates as high as 15% (1,2,3).

Known driving factors are numerous. They can be classified into bone and capsule-activity-ligament, and are frequently entangled. Bone-promoting factors are related to hyper-reduction of metatarsus varus by excessive lateral translation of the M1 during any...

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