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Scarf and Akin Osteotomies | One Way to Correct Hallux Valgus | Find Your Stride | Edinburgh Podiatrist

Introduction

Hallux valgus, more commonly known as a bunion, is a common foot deformity that affects millions of people worldwide. It is characterised by a bony bump that forms on the joint at the base of the big toe, causing the toe to bend towards the other toes. This can lead to pain, swelling, redness, and limited movement in the affected toe. In severe cases, bunions can make it difficult to walk or wear shoes comfortably.


x-ray of a foot with hallux valgus
Hallux valgus (bunion) causes pain at the 1st metatarsophalangeal joint

When should surgery be considered for hallux valgus?

Surgery is typically considered when conservative treatments, such as wearing wider shoes, using orthotic devices, and steroid injections, fail to provide relief. Other factors that may indicate the need for surgery include persistent pain, difficulty walking, sleep disturbance, deformity of the toe, and interference with daily activities. Typically general practitioners will evaluate associated symptoms and refer on to an orthopaedic surgeon or podiatrist for a surgical opinion when appropriate.


What are scarf and akin osteotomies?

One common surgical procedure used to correct hallux valgus is known as 'scarf and akin' which describes the different 'bone cuts' or osteotomies required during surgery. This procedure involves making a series of cuts in the bones that make up the big toe joint before realigning them to correct the deformity. The scarf osteotomy is performed on the metatarsal bone (the long bone in the foot), while the akin osteotomy is performed on the phalanx bone (the bone in the toe). Together, these procedures help to straighten the toe and realign the joint for improved function and appearance.


What does the procedure involve?

During this type of surgery, the patient is generally placed under general anesthesia, the surgeon then makes an incision on the top or side of the foot to access the bones of the big toe joint. They then carefully cut and realign the bones using specialised instruments and techniques. Once the bones are in the correct position, they are secured with screws, staples or plates to hold them in place while they heal. The skin is then closed with stitches, and a bandage is applied to protect the foot.


How long does it take to heal?

Recovery times after scarf and akin surgery can vary depending on the individual and the severity of the deformity. In general, patients can expect to wear a special surgical shoe or cast for several weeks to protect the foot and aid in healing. Physical therapy may be recommended to help restore strength and mobility in the foot. Most patients are able to return to regular activities within 12 weeks, although full recovery can take up to 12 months.

As with any surgical procedure, there are associated risks. These risks include infection, bleeding, nerve damage, delayed healing, and recurrence of the deformity. Your surgeon will discuss these risks with you before the surgery and take steps to minimise them before, during and after the procedure. It is important to follow your surgeons post-operative instructions carefully to reduce the risk of complications and promote a successful recovery.


Conclusion

In conclusion, scarf and akin osteotomies are specific bone cuts used to surgically correct hallux valgus, with the aim of relieving pain and discomfort associated with bunions. If conservative treatments have failed to improve symptoms, surgery may be recommended to restore proper function and improve the appearance of the foot. While there are associated risks, this procedure is generally safe and effective when carried out by a skilled and experienced surgeon. If you are considering surgery for hallux valgus, be sure to discuss the procedure in detail with your surgeon, and ask any questions you may have so that you can make an informed decision about your treatment.


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