SLR - November 2023 - Banerjee
Title: Effect of Scarf and Chevron combined with Akin on postoperative balance in patients with moderate to severe foot bunionReference: Wu JD, Chen ZU, Qi YZ, Li XY, Pan XU, Hong MA, Jin BR, Ma ZU. Effect of Scarf and Chevron combined with Akin on postoperative balance in patients with moderate to severe foot bunion. Eur Rev Med Pharmacol Sci. 2023 Sep;27(17):8225-8233. doi: 10.26355/eurrev_202309_33583. PMID: 37750651
Level of Evidence: 1
Reviewed By: Nicholas Banerjee
Residency Program: New York College of Podiatric Medicine NY,NY
Podiatric Relevance: The purpose of this study is to measure post inflammatory markers/oxidate stress mediators and post operative pain between Scarf with akin osteotomy vs chevron with akin osteotomy when surgically fixating moderate to severe bunion deformities.
Methods: 100 participants were divided into 2 groups: chevron with akin osteotomies (Study group) vs scarf with akin Osteotomies (control group).
Oxidative stress mediators [late oxidized protein product (AOPP), lipid peroxide (LPO)], inflammatory factors [interleukin-1β (IL-1β), procalcitonin , Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal joint angle, ankle-hind foot American Orthotic Foot and Ankle Association (AOFAS) score, Berg Balance Scale (BBS) score, pain visual analog scale score and balance Berg Balance Scale were measured pre and post-operatively
Post-operative complications were also compared between the two groups
Inclusion Criteria (1) All subjects were diagnosed with hallux valgus by clinical examination and imaging13. (2) Conservative treatment was ineffective and affected patients’ daily life. (3) The patient voluntarily requested surgery. (4) Patients and their families were able to understand the operation and signed the informed consent form, which was approved and implemented by the hospital Ethics Committee.
Exclusion Criteria (1) Mental disorders or malignant tumors. (2) Pregnant and lactating women. (3) Patients who were unable to cooperate with the treatment.
The control group resulted post-operatively with relatively higher Oxidative stress mediators, lipid peroxide markers, inflammatory factors [interleukin-1β (IL-1β), and procalcitonin markers, when compared to the study group which the index of thehallux valgus angles, intermetatarsal angles, distal metatarsal joint angles increased statistically significantly, post-operatively. However, the VAS score was decreased statistically significantly post operatively in the study group
Results: The table below represents pre and post operative values for the oxidative stress factors, inflammatory factors, and various angles
Group AOPP Pre/post op LPO Pre/post op Il-1 Beta Pre/post op IMA Pre/Post op DMAA Pre/post op HVA Pre/post op PCT Pre/post
Control 12.3/32.6 8.5/21.6 3.8/8.9 21.3/13.8 16.5/10.5 38.6/26.3 2.4/7.6
Study 15.2/25.4 8.4/16.3 3.7/16.3 21.3/8.5 16.6/7.5 38.7/15.7 2.2/4.9
Conclusion: Although the scarf (mid) osteotomy is typically used for moderate/severe bunion deformities while the Chevron (distal) osteotomy is used for mild/moderate, in this study the chevron osteotomy with akin resulted in more reduced HVA, IMA, and DMAA angles when compared to scarf + akin osteotomies. The study group also resulted in lower inflammatory markers as well as better balance and less pain even when ambulating when compared to the control group. All in all, chevron + akin osteotomy (distal) should be considered in surgically fixating a moderate/severe bunion deformity because a more proximal osteotomy such as a scarf osteotomy may likely cause more inflammatory factors, post-operative pain, post-operative complications, and less reduction.