Calcaneal Osteotomy Combined With Scarf And Akin Osteotomy For The Treatment Of Adult Acquired Flatfoot With Moderate To Severe Hallux Valgus

Objective:To observe the efficacy of medial displacement calcaneal osteotomy combined with Scarf osteotomy and Akin osteotomy in the treatment of adult acquired flatfoot with moderate to severe hallux valgus through clinical and imaging examination results,so as to provide guidance for the surgical method of adult acquired flatfoot with moderate to severe hallux valgus clinically.Method:From January 2015 to September 2017,34 cases(45 feet)of adult acquired flatfoot with moderate or severe hallux valgus were admitted to the foot and ankle surgery department of XI`an Hong Hui Hospital,and all the patients received conservative treatment for more than 1 year before surgery,after the treatment was ineffective,those chose to come to our department for surgery.Among them,16 cases(20 feet)males and 18 cases(25 feet)females,aged from 38 to 69 years,with an average age of 45.1±5.8 years.All patients received medial displacement calcaneal osteotomy for correction valgus deformity of hindfoot,and correction hallux valgus deformity with Scarf osteotomy and Akin osteotomy.Patients with preoperative and postoperative follow-up records of Maryland foot scoring system(Maryland score)and load state of pain score(VAS score),preoperative and postoperative follow-up,the weight bearing anteroposterior/lateral and hindfoot Saltzman X ray film was taken.And recorded the changement of inclination angle(CIA),talocalcaneal angle(kite),talar first metatarsal angle(Meary ' s)in lateral X-ray;the Talonavicular coverage angle(TCA),talar first metatarsal angle(T1M1),hallux valgus angle(HVA),intermetatarsal angle(IMA)and distal metatarsal articular angle(DMAA)of the weight-bearing Anteroposterior x-ray,and hindfoot alignment angle of Saltzman position(HAA).Postoperative and follow-up complications and the satisfaction rate of patients were recorded.Results:All the 34 patients(45 feet)were followed up for 12 to 36 months,with an average follow-up time of(21.8±6.2)months.Superficial wound infection occurred in 2 patients after surgery,and improved after oral antibiotics and dressing change,Eventually all wounds healed well.At the final follow-up patients Maryland score was(87.1± 5.2)points,VAS pain score was(1.3 ± 0.7),compared with preoperative were statistically significant(P < 0.01).Postoperative weight-bearing lateral radiographs of calcaneus inclination angle(CIA),and talocalcaneal angle(Kite)and talar first metatarsal angle(Meary's);weightbearing anteroposterior radiograph of the talonavicular coverage angle(TCA),talus first metatarsal angle(T1M1),hallux valgus angle(HVA),intermetatarsal angle(IMA)and distal metatarsal articular angle(DMAA),compared with preoperative,the differences were statistically significant(P < 0.01).and weight-bearing hindfoot alignment angle of Saltzman position(HAA),was significantly different from preoperative(P <0.01).Postoperative no complications related to internal fixation occurred.One patient had residual flatfoot deformity.One patient showed recurrence of hallux valgus postoperative follow-up.One patient occured hallux varus deformity.In other patients,the foot deformity such as flat foot and hallux valgus were obviously improved and the pain disappeared.Postoperative satisfaction survey: very satisfied 21 cases,satisfied 9 cases,general 3 cases,poor 1 case,total satisfaction rate of 88.2%.Conclusion:It is relatively safe and effective to treat the Adult-Acquired Flatfoot with moderate and severe hallux valgus through the medial displacement calcaneal osteotomy combined with Scarf osteotomy and Akin osteotomy.Postoperative hallux valgus deformity and flat foot deformity of the patients were significantly corrected,and the pain symptoms of the patients were alleviated significantly.Postoperative total satisfaction rate of patients is high.