Rotational Scarf and Akin Osteotomy for Correction of Hallux Valgus Associated with Metatarsus Adductus

Background: The presence of metatarsus adductus can complicate hallux valgus surgery. It reduces the gap between the first and second metatarsal and can restrict the transposition of the first metatarsal head. It also confounds the measurement of the first second intermetatarsal angle. Materials and Methods: Twenty-seven patients, (124 female, 38 feet), of average age 59 (SD 23) with symptomatic hallux valgus associated with metatarsus adductus underwent a rotation scarf with Akin osteotomy and were reviewed at an average of 59 (SD 23) months postop. Standard radiographic assessment of the hallux valgus was undertaken as well as measurement of the metatarsus adductus using the Kilmartin angle and the intermetatarsal angle of Engel. Results: The mean preoperative intermetatarsal and hallux valgus angles were 14 degrees (SD 4) and 35 degrees (SD 7.4) respectively. The mean postoperative intermetatarsal and hallux valgus angles were 3.9 degrees (S.D. 3.3) and 13.2 degrees (SD 9.4) (p < 0.0001). The confounding effect of metatarsus adductus was evaluated using the Kilmartin angle and the intermetatarsal angle of Engel which significantly improved with surgery (p < 0.0001). Conclusion: The rotation scarf & Akin osteotomy was an effective procedure for correcting hallux vaigus associated with metatarsus adductus. It allowed good realignment of the first MTP joint without the need for lesser metatarsal surgery to reduce the metatarsus adductus.