Scarf osteotomy versus metatarsophalangeal arthrodesis in forefoot first ray disorders: comparison of functional outcomes.

INTRODUCTION: Scarf osteotomies of the first metatarsal and metatarsophalangeal arthrodesis are the two most frequent surgical forefoot reconstructive procedures.

HYPOTHESIS: We compared functional results of isolated arthrodesis of the first metatarsophalangeal joint with an isolated Scarf osteotomy of the first metatarsal.

MATERIALS AND METHODS: This was a retrospective, observational, continuous study of patients operated between 1993 and 2008. After patients who had undergone a procedure on the lateral rays, extremely elderly patients, lost to follow-up patients and those with incomplete questionnaires had been excluded, there remained two comparable groups of 25 patients. Mean age was 60 in the arthrodesis group [41-70] and 59.8 in the Scarf group [47-71]. The Scarf group included 25 hallux valgus (100%) compared to 16 hallux valgus (64%) and nine hallux rigidus (36%) in the arthrodesis group. Complications were recorded. Evaluation of functional results was based on the most recent functional or quality of life scores (AOFAS, FFI, FAAM, SF 36) and a questionnaire on physical and athletic ability.

RESULTS: There was no significant difference in the rate of complications between the two groups. There was no difference in pain according to the AOFAS score with 35.6/40 (± 6.5) in the Scarf group and 34.5 (± 5.9) in the arthrodesis group. Global satisfaction was also similar between the Scarf and arthrodesis groups: 91.4% and 90% of very satisfied or satisfied patients, respectively. The FFI score was higher in the Scarf group than in the arthrodesis group: 8.6 (± 20.1) and 19.8 (± 17.7) respectively. Functional results were better in the Scarf group than in the arthrodesis group with a FAAM Daily Activity score of 80.2 (± 12.1) compared to 68 (± 7.2), a FAAM Sports Activity score of 29.7 (± 6.7) compared to 25.2 (± 7.6) and a FAAM Global Function score of 94% (± 10.8) compared to 87% (± 15.7), respectively. The Global SF36 score was higher in the Scarf group than in the arthrodesis group: 70.9% (± 14.1) and 62.3% (± 20.6) respectively, which was due to a higher Mental Health score in the Scarf group: 68.7% (± 14.2) and 60.4% (± 19.3) respectively. In the area of sports activities the Scarf group practiced more hiking than the arthrodesis group (74% versus 42% respectively). There was no difference for other activities.

DISCUSSION AND CONCLUSION: This study provides detailed information on the level of physical and sports activities that are practiced following these procedures, so that the patient can be better informed.