Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy

Abstract

Background: Hallux valgus recurrence is an unsatisfactory complication, with many causes postulated. This study investigated the effect of pes planus on recurrence after scarf osteotomy. Methods: A total of 183 feet were retrospectively reviewed. All patients were treated with a scarf osteotomy and if required Akin osteotomy. We measured preoperative lateral talus first metatarsal angle (T1MA) to study pes planus; an angle of under −4 degrees was considered pes planus. We measured pre and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and sesamoid location. In total 164 feet were suitable for inclusion, with follow-up of at least 6 months (10 males and 154 females, mean age: 52 years). Results: Recurrence frequency (HVA greater than 15 degrees) was 27 feet (16%). Hallux valgus recurrence was not influenced by gender ( P value = .66) or preoperative IMA ( P value = .48). Preoperative HVA greater than 35 degrees was associated with increased frequency of recurrence ( P value = .004). Those with T1MA less than −10 degrees demonstrated progression in HVA and deterioration in sesamoid location up to 6 months postoperatively ( P value = .038). HVA did not progress beyond 6 months. The prevalence of recurrent hallux valgus with normal T1MA was 1%, in T1MA −4 to −10 degrees it was 29% and in T1MA less than −10 degrees it was 47% ( P value <.001). Breaks in T1MA less than −4 degrees were found at the naviculocuneiform joint in 68% of feet in this series. Conclusion: The prevalence of hallux valgus recurrence correlated with the severity of pes planus. Level of Evidence: Level III, retrospective cohort study.

First Metatarsal Rotation in Hallux Valgus Deformity

“…42 Since its formal introduction in the 19th century, hallux valgus (HV) deformity has been one of the most commonly investigated and treated pathologies of the foot owing to its high prevalence and symptomatic nature. 12,27,32,38,41,44,50,52,54,78,96 Although HV has received a considerable amount of scientific attention over the last century, its pathogenesis is still not entirely understood. 23,63…”

Response to “Letter Regarding: Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy”

“…2 That pathology is complex and not fully understood when considered in the context of a concomitant pes planus deformity. 1,3,5 The surgical technique used was as per the previously published descriptions from your unit. 4,6 Our standard practice is to make a Z osteotomy by producing a longitudinal axial cut starting 5 mm from the dorsal surface of the metatarsal head and moving proximally to the inferior flare of the metatarsal shaft.…”

“…That pathology is complex and not fully understood when considered in the context of a concomitant pes planus deformity. 1,3,5…”

Letter Regarding: Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy

“…We read with great interest recent publication of the article by Heyes et al 3 The authors investigated the effect of pes planus on recurrence after scarf osteotomy and concluded that the prevalence of hallux valgus recurrence correlated with the severity of flatfoot.…”

“…Although we are impressed, there are some concerns regarding their study. First, Heyes et al 3 measured the preoperative lateral talus first metatarsal angle (T1MA) and divided their cohort into 3 groups depending on the severity of the pes planus (normal, mild, and severe). They did not measure postoperative T1MA.…”