Abstract
Scarf osteotomy of the first ray combined with Weil distal oblique shortening osteotomies
of the lateral rays has recently been proposed for the treatment of global rheumatoid
forefoot deformities because of the perceived benefit of sparing the metatarsal-phalangeal
joints. Furthermore, it has been proposed that undergoing this form of global forefoot
reconstruction is reliable based on specific preoperative and intraoperative techniques
used to realign the individual rays. Finally, it has been proposed that performing
global forefoot reconstruction in the rheumatoid patient population can be safely
performed and does not prevent the ability to perform revision surgery. The author
undertook a systematic review of electronic databases and other relevant sources to
identify material relating to Scarf osteotomy of the first ray combined with Weil
distal oblique shortening osteotomies of the lateral rays for the treatment of global
rheumatoid forefoot deformities. Information from peer-reviewed journals, as well
as from non–peer-reviewed publications, abstracts and posters, textbooks, and unpublished
works, was also considered. In an effort to procure the highest quality studies available,
studies were eligible for inclusion only if they involved patients undergoing Scarf
osteotomy of the first ray combined with Weil distal oblique shortening osteotomies
of the lateral rays, evaluated patients at mean follow-up of 12-months or longer duration,
commented on the reliability of metatarsal realignment, and included details of complications,
as well as the incidence and severity of wound-healing complications. Two studies
were identified that met the inclusion criteria involving only 8 patients (8 feet)
with 1 patient undergoing surgical revision in the form of arthrodesis secondary to
development of a septic first metatarsal–phalangeal joint. Partial incision dehiscence
developed in 2 patients, 1 healed with local wound care and the other led to the septic
first metatarsal–phalangeal joint mentioned previously. Finally, stress fracture of
the third metatarsal and fourth metatarsals developed that healed without problems
in one other patient. Rather than providing strong evidence for or against the use
of Scarf osteotomy of the first ray combined with Weil distal oblique shortening osteotomies
of the lateral rays for the treatment of global rheumatoid forefoot deformities, the
results of this systematic review make clear the need for methodologically sound prospective
cohort studies and randomized controlled trials that focus on the use of this form
of surgical intervention.
Level of Evidence
Keywords
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Article info
Publication history
Published online: April 26, 2010
Footnotes
Disclaimer: The opinions or assertions contained herein are the private view of the author and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
