• Foot & Ankle Conditions
• Orthopaedic Procedures
• Orthopaedics Clinical Trials

• Foot & Ankle Conditions
• Orthopaedics
• Orthopaedic Procedures
• Orthopaedics Clinical Trials

Minimally invasive chevron/akin (MICA) osteotomies resulted in less pain, shorter operation time, shorter scar length, and greater patient satisfaction rates compared with scarf/akin osteotomies for the treatment of hallux valgus. Peter Lam, MD, Orthopaedic Foot and Ankle Specialist, Sydney, Australia, presented data from a prospective study comparing scarf/akin osteotomies with MICA osteotomies for the treatment of hallux valgus.

Although the scarf method for hallux valgus correction is popular in Sydney, there have been no published, randomized trials comparing the technique with the MICA osteotomy method. The scarf method can correct an intermetatarsal angle (IMA) of up to 6°, but structural failure at the proximal aspect can occur. Troughing may also be seen in up to 35% of cases.

In this prospective, single-center study, 51 patients were randomly assigned to undergo scarf or MICA osteotomy. The end points of the study included the Visual Analog Scale (VAS) for pain, radiographic review, and the American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale.

There was no significant difference between the scarf and MICA groups in the AOFAS forefoot score; the postoperative score was 83 in the scarf group (95% CI, 83 to 87) and 89 in the MICA group (95% CI, 87 to 91). The IMA was also not significantly different between the 2 groups at 6 weeks or 6 months after the procedure (P = .25). However, the hallux valgus angle (HVA) was significantly better in the MICA arm at both 6 weeks and 6 months after the procedure (P = .033). Pain score, as measured by the VAS, was significantly lower in the MICA arm compared with the scarf arm at 1 day (P < .001), 2 weeks (P < .001), and 6 weeks (P = .004); however, there was no significant difference in pain scores at 26 weeks (Figure 1). The operation time was longer with the scarf approach (mean of 33.7 minutes) compared with the MICA approach (mean of 29.7 minutes). In addition, the mean length of the combined scar was 108 mm in the scarf group compared with 24.2 mm in the MICA group.

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Figure 1.

Effect of Minimally Invasive Chevron/Akin Osteotomy on Pain

MICA, minimally invasive chevron/akin osteotomy; VAS, Visual Analog Scale.Reproduced with permission from P Lam, MD.

In the scarf group, complications included 2 cases of mild second metatarsalgia and 1 case of increased depth of forefoot. In the MICA group, there were 6 cases of screw removal. Overall ratings of the scarf or MICA methods indicated that patients were satisfied (7 vs 4, respectively) or extremely satisfied (18 vs 21, respectively); no patients reported being unsatisfied or extremely unsatisfied with either method.

According to Dr Lam, the use of MICA was associated with less pain, greater improvement in HVA, shorter operation time, and shorter scar length. Overall, the same number of patients was satisfied with either method.

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