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Introduction: The scarf osteotomy is a reliable surgical technique for treating hallux valgus. The aim of our study was to analyze the occurrence of transfer metatarsalgia after surgery on the first ray using a screwless Scarf osteotomy technique that we have been using in our department since 1995, which consists of stabilization by axial impaction without internal fixation. We hypothesized that the alleged shortening of the first metatarsal produced by this technique may be at the origin of postoperative metatarsalgia., Patients and Methods: This was a case series of first ray metatarsal screwless Scarf osteotomies reviewed in the medium term. We did a clinical and radiological review of all patients operated using this technique between 2012 and 2017 who did not meet the following exclusion criteria: procedure on the other lateral metatarsals, concurrent hindfoot pathology, incomplete medical records., Results: Of 114 feet, 96 were included in the study and 18 were excluded. The mean follow-up was 1 year and 8 months [1-4years]. The mean AOFAS score was 90.3 and 96% of patients were either satisfied or very satisfied with the outcome. All the parameters improved significantly: shoe wearing, pain, function, alignment. Fourteen feet had transfer metatarsalgia, which appeared during the first year postoperative (AOFAS 75/100). Ten other complications occurred: two Morton's neuromas, three cases of complex regional pain syndrome, one superficial infection, one paresthesia, two recurrences with surgical revision, one nonunion. No general complications were found. Based on radiographs, the mean M1 shortening was 3.3mm (6.3mm in metatarsalgia group versus 3.0 mm in the non-metatarsalgia group, P=0.2) and the mean angular correction was 16.2° (±6°)., Discussion: The overall results of screwless Scarf osteotomy are comparable and satisfactory, allowing large deformities to be corrected (28°±8° preoperatively in our cohort). M1 shortening and the transfer metatarsalgia rate appear to be higher than with other techniques., Conclusion: Screwless scarf osteotomy of M1 yields good functional and radiological outcomes in the medium term. However, it appears to cause more shortening and transfer metatarsalgia., Level of Evidence: IV Retrospective, non-interventional in current practice (Recommendation grade C, low level of scientific proof)., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose of the Study: Little work has been reported on the treatment of recurrent hallux valgus. We reviewed 64 cases after surgical treatment in order to ascertain the cause of recurrence, results of the treatment given, and deduce therapeutic options and indications., Material and Methods: Fifty-nine patients had 64 recurrent hallux valgus bunions. Mean age of the patients was 58 years, 54 women and 5 men. The clinical and radiographic preoperative work-up led to two categories of treatments. In 35 cases, conservative treatment was used to re-align the axis by procedures on the soft tissues either alone or in combination with MacBride tendon transfers, metatarsal osteotomies, or osteotomies to shorten the first phalange. In 29 cases, metatarsophalangeal arthrodesis was used. Patient satisfaction, pain, deformation, shoe wearing and activity were recorded at follow-up. The same radiological parameters were used postoperatively to assess anatomic results., Results: Mean follow-up was more than 6 years (range 2-18 years). The subjective result was good in 52 cases. The objective result was good in 50 cases and poor in 14 (including 7 cases with insufficient correction). The results were analyzed by type of treatment., Discussion: The preoperative analysis demonstrated that recurrence is due to insufficient initial treatment which must take into account all the components leading to the deformation. Arthrodesis gave a good result in 83% of the cases and conservative treatment gave a good result in 71%. Thus, in our opinion, no one type of treatment of recurrent hallux valgus can be applied for all patients. Nevertheless, conservative treatment should associate complementary procedures that can be deduced from the clinical and radiological analysis.

Purpose of the Study: Arthrodesis-reconstruction for metatarsophanlangeal bone defects of the great toe after hallux valgus or hallux rigidus is rarely performed and only a few series are found in the literature. In these series, retarded bone fusion, skin rupture, and interphalangeal intolerance (both clinically and radiologically) have been frequent. The purpose of this work was to determine what parameters contribute to minimizing these postoperative risks., Material and Methods: Thirteen patients, mean age 60 years, were reviewed at a mean follow-up of 7 years. Mean delay from initial surgery to revision surgery was greater than 6 years. Preoperative complaints included metatarsophalangeal pain and especially transfer metatarsalgia. The procedure used corticocancellous bone grafting associated with osteosynthesis and unloading of the forefoot for three months., Results: Eleven of the 13 patients achieved full relief of their metatarsophalangeal pain and metatarsalgia. Twelve of the 13 patients had a satisfactory great toe axis, including 2 who had a secondary osteotomy for correction. Bone fusion was achieved in all 13 patients; one at 8 months. Mean lengthening was 5.1 mm; reconstruction with the corticocancellous graft reconstruction generally filled the bone defect resulting from ablation of the joint prosthesis in 7 cases. The interphalangeal joint was pain free at last follow-up in all cases despite radiological evidence of suffering in one (similar to the situation before the revision surgery)., Discussion and Conclusion: Correct position of the arthrodesis is essential to alleviate transfer metatarsalgia. A moderate lengthening of the great toe can minimize the risk of skin rupture. In order to preserve the interphalangeal joint, the position of the arthrodesis must be precise both in the sagittal and horizontal plane, leaving sufficient valgus and avoiding the need for temporary interphalangeal pinning.

This study reports an analysis of a series of 316 cases of hallux valgus treated by a method derived from McBride's operation with some modifications and combined with bony procedures designed to correct abnormalities of bony architecture, in particular osteotomy to shorten an excessively long proximal phalanx. Two hundred feet were reviewed with a follow-up between 1 and 13 years. The results, which were satisfactory in 80 per cent of cases, were analysed according to the usual parameters of pain and deformity in relation to the pre-operative findings and the surgical methods used. The failures and complications were analysed. The results of this study makes it possible to determine the indications for and to appreciate the value and advisability of technical modifications.