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. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.