Hallux abducto valgus (HAV), the bunion deformity, is one of the most common presentations in foot and ankle practice [1, 2]. It is a complicated multiplanar pathology and is characterised by lateral deviation and valgus rotation of the hallux and medial deviation of the first metatarsal [1, 3, 4]. It has been reported that approximately 23% of adults aged between 18 and 65 years have the deformity, which increases to 35.7% of the population above 65 years of age [3]. It has a higher female predilection and can often result in a decreased quality of life [5]. HAV is often intractable despite conservative care, ultimately requiring a surgical correction for many patients after a failure of conservative care [1, 2]. Over a hundred different surgical solutions have been proposed throughout the literature with varying outcomes [6, 7]. Schrier et al. [8] suggested that up to a third of patients operated on for HAV may be dissatisfied with the outcome of their surgery (though the paper they attribute this value to in fact demonstrated good patient outcomes). Patient reported outcomes are now crucial in capturing and evaluating treatment effectiveness.

Although no single surgical procedure has shown superiority, the scarf osteotomy is a popular choice in HAV correction due to its versatility in treating mild, moderate, and even severe HAV deformity [9,10,11,12,13]. The ‘scarf’ term is derived from a carpentry method where two pieces of wood are joined together with the long ends overlapping. This creates stability via a construct which can resist tension and compression forces [14]. The scarf osteotomy was traditionally be performed via translation (see Figs. 1 and 2) or rotation of the osteotomy fragment, the latter technique utilised for deformities with higher intermetatarsal angle (IMA) [15]. Lopez et al [7] describe the translation and rotation procedure or ‘trotation’ scarf osteotomy (see Figs. 3 and 4). The scarf osteotomy is often undertaken alongside an Akin osteotomy (a phalangeal, closing adductory wedge osteotomy) to augment the hallux abductus component of the HAV deformity [16].

Translation scarf – direct lateral translation of the capital fragment

Translation scarf (saw bone)

Trotations scarf – translation and lateral rotation of the capital fragment

Fixation of the scarf osteotomy may vary from surgeon to surgeon but most commonly, two points of internal fixation are used. In more recent years, cannulated compression screws have been used where AO cortical screws were previously the norm. Some surgeons choose to use a Kirschner (K) wire and a screw as their chosen two points of fixation, e.g., Lopez et al [7]. The Akin osteotomy may be fixed with either a single threaded K wire, a staple, or screw, as the intact lateral hinge is utilised as the second point of fixation.

Foot health outcome measurement tools can be used to improve service delivery by collating and evaluating parameters such as pain, foot function, footwear, and mobility [17]. The Podiatric Audit of Surgery and Clinical Outcome Measurement system (PASCOM) was developed by the College of Podiatry in 1997 with the updated PASCOM-10 introduced to the podiatric surgery profession in the UK in 2010 [18]. It provides a structured framework in which to collate and compare data relating to the characteristics, outcome, and patient experiences of foot surgery [19]. It is a web-based database of podiatric procedures and outcomes which allows for retrospective reviews [20].

PASCOM-10 has three domains with the first encompassing the surgical treatment, the second relating to post-operative sequelae with the final section housing the patient satisfaction questionnaire (PSQ-10, 18]. The PSQ-10 questionnaire has ten questions (see Additional file 1) with the first asking the patient an open-ended question about their expectations of their surgery. The following nine answers are scored with a maximum of 100 points. Higher scores are an indication of high levels of satisfaction, whilst a minimum score of zero indicates the opposite [17, 19]. The PSQ-10 has not undergone formal validation, although it has reliably demonstrated that satisfaction do no change over time [17, 19].

Trotation scarf (saw bone)

Digital PASCOM-10 files are created when a patient is listed for surgical intervention and data is collated on the surgical information, complications, satisfaction, and patient reported outcome measure (PROM) scores. Activity is entered by clinical or administrative staff on the day of surgery and then at a 6 month post-surgical review [21], at which point the PSQ-10 questionnaire is completed together with the recording of any post-operative sequelae. If a patient fails to attend the 6-month review, there is an option for the questionnaire to be emailed to the patient, but often these episodes are lost to follow up.

This aim of this paper was to review the subjective evaluation of the patients’ outcome and recorded clinical sequelae across five podiatric surgery centres over a 10 year period. Incidental but valuable data relating to pre-operative surgeon/patient conversation was also captured.