Comparison of Scarf With and Without Akin Osteotomy for Hallux Valgus

Introduction Hallux valgus (HV) is a common foot deformity characterized by misalignment of the first metatarsophalangeal joint, often impacting quality of life. Its causes are multifactorial, including genetics, lifestyle, and improper footwear. Management ranges from conservative approaches to surgical correction, with Scarf osteotomy commonly used. This study aims to compare outcomes of Scarf osteotomy with and without Akin osteotomy in a Saudi population. Methodology This is a retrospective cohort study conducted at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, analyzing outcomes of Scarf osteotomy with and without Akin for a total of 148 patients. The study included all patients who underwent the procedure between 2016 and 2024 who had available and accessible medical records. The surgeries were performed and supervised by an entire team consisting of three consultants with fellowship training in foot and ankle surgery in KAMC Riyadh. Data from 2016 to 2024 were extracted from BestCare (a health information system for medical records), using convenience sampling. The data were cleaned in Excel (Microsoft® Corp., Redmond, WA) and analyzed in Statistical Product and Service Solutions (SPSS, version 29.0.0; IBM SPSS Statistics for Windows, Armonk, NY). Results This study included 148 patients (177 feet) undergoing Scarf osteotomy (Scarf alone: 75 (50.7%), Scarf with Akin: 73 (49.3%)). All patients were followed for at least one year after surgery, providing enough time to observe long-term outcomes and recurrence. The majority were female (140 (94.6%)), aged 31-40 years (42 (28.4%)). Post-operative pain was reported in 49 (33.1%), recurrence in 12 (8.1%), and non-union in 6 (4.1 %). Radiologically, significant improvements were observed in the intermetatarsal angle (IMA) (right: -7.48°, p<0.001; left: -9.32°, p<0.001), HV angle (HVA) (right: -20.27°, p<0.001; left: -21.92°, p<0.001), and distal metatarsal articular angle (DMAA) (right: -10.53°, p<0.001; left: -12.00°, p<0.001). Scarf with Akin showed superior angular correction (HVA reduction: 22.92° vs. 17.50°; p<0.001). Among severe cases (n=31), the IMA improved by 10.37° vs 9.25° (right) and 11.92° vs 12.42° (left) in the Scarf with Akin and Scarf alone groups, respectively. HVA correction was greater with Scarf and Akin - 26.00° vs 23.00° (right) and 29.83° vs 28.86° (left) - demonstrating its superior efficacy. Postoperative pain occurred in 31.7% of patients, with higher rates in the Akin group. Conclusion This study shows both Scarf and Scarf with Akin osteotomies effectively corrected HV deformities with low complication rates. Scarf with Akin achieved greater angular correction, particularly in severe deformities, but at the cost of slightly increased postoperative pain. However, Scarf alone had slightly better sesamoid realignment. Postoperative pain was the most common complication, with BMI being the only significant predictor, highlighting the importance of weight management in surgical recovery.