Minimally Invasive Scarf Calcaneal Osteotomy is an Alternative Technique for the Correction of Progressive Collapsing Foot Deformity

Abstract

Scarf calcaneal osteotomy is an extra-articular procedure to correct progressive collapsing foot deformity (PCFD). As an open approach may display wound healing problems, we herein report a novel method of percutaneously performed minimally invasive scarf calcaneal osteotomy. Twenty patients aged 56.75 ± 7.13 with grade 1AB of PCFD were included. A radiologic assessment was performed before the procedure and after 3 months. Clinical evaluation was done before the procedure, after 3 months, and after 12 months. The Manchester-Oxford Foot Questionnaire and Functional Foot Index score improved from 77.63 ± 11.67 preoperatively to 33.29 ± 18.55 at the follow-up (P < 0.001) and from 69.26 ± 16.32 preoperatively to 32.00 ± 20.35 at the follow-up (P < 0.001), respectively. There was a statistically significant improvement in all radiologic measurements, namely, talonavicular coverage angle from 20.03 ± 5.51 to 14.18 ± 6.49 (P < 0.001), the distance between medial cuneiform and fifth metatarsal from 0.53 ± 3.31 to 6.95 ± 4.01 (P < 0.001), anteroposterior talo-first metatarsal angle from 22.13 ± 7.28 to 17.09 ± 6.87 (P < 0.005), Meary angle from 25.12 ± 2.73 to 15.17 ± 7.06 (P < 0.001), calcaneal inclination angle from 12.23 ± 4.01 to 16.82 ± 5.53 (P < 0.001), navicular height from 15.57 ± 4.10 to 20.57 ± 6.87 (P < 0.005), and tibio-calcaneal angle from −3.79 ± 5.15 to 6.71 ± 4.41 (P < 0.001). In experienced hands, minimally invasive scarf calcaneal osteotomy seems to be an effective and reproducible subtalar preserving surgical technique for PCFD cases with mild midfoot abduction severity. Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.