Flatfoot as a key factor for hallux valgus recurrence after Scarf and Akin osteotomies in patients with rheumatoid arthritis.

Abstract

Joint-preserving procedures such as Scarf osteotomies have been increasingly utilized for hallux valgus (HV) in rheumatoid arthritis (RA). While recurrence remains a concern, its association with foot arch alignment is not well understood. To identify preoperative factors, including foot arch alignment, associated with HV recurrence after Scarf and Akin osteotomies in patients with RA. Retrospective case series. A retrospective analysis was conducted on 49 feet from 41 RA patients who underwent Scarf and Akin osteotomies between 2016 and 2021. Recurrence was defined as an HV angle (HVA) ≥ 20° at 2 years postoperatively, excluding cases with HVA ≥ 20° at 3 months to eliminate early correction failure. Radiographic and clinical parameters were compared between recurrence and non-recurrence groups. After excluding 6 early failure cases, recurrence was observed in 5 feet (11.6%). Significant factors included greater preoperative talonavicular uncoverage percentage (29.7% vs. 20.6%, p = 0.013), higher preoperative Meary's angle (12.3° vs. 3.3°, p = 0.030) and larger first-second intermetatarsal angle (20.0° vs. 15.7°, p = 0.015). Preoperative HVA, calcaneal pitch, or sesamoid position showed no significant difference. Preoperative flatfoot and metatarsal divergence were associated with HV recurrence after Scarf and Akin osteotomies in RA patients. Preoperative assessment of foot arch alignment may help stratify recurrence risk and inform surgical decision-making. Level IV.