{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T08:26:46Z","timestamp":1767169606553,"version":"3.48.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007195","name":"Universit\u00e0 degli Studi di Napoli Federico II","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007195","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Scarf-Akin osteotomy (with or without lateral soft-tissue release (LSTR)) is commonly performed to treat hallux valgus (HV). An insufficient correction of sesamoids can be a risk factor for early recurrence of the condition. We set out to determine 1) the radiographic correction achieved after Scarf-Akin osteotomy performed without LSTR and 2) the degree of correction of sesamoids obtained during the learning curve of the technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>In this prospective single-centre study, the first 25 feet (25 patients, mean age 55.2\u00a0years, 14 left) undergone Scarf-Akin osteotomy without LSTR by a single foot and ankle orthopaedic consultant in his first year of activity were enrolled and followed-up at 1-year. On weightbearing standard pre-operative and 1-year follow-up radiographs two independent observers (senior residents) assessed and compared the hallux valgus angle (HVA), 1st and 2nd intermetatarsal Angle (IMA), distal metatarsal articular angle (DMAA) and tibial sesamoid position (SP, according to the Hardy and Clapham system). The inter and intraobserver reliability of measurements along with the correlation between the improvement achieved in different parameters and the number of cases performed were tested. Intra and post-operative complications were compared between the early (first 12) and late learning periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The inter and intraobserver agreement for the radiographic parameters investigated was excellent in all cases (ICC always\u2009&gt;\u20090.92). A statistically significant improvement in mean HVA (from 36\u2009\u00b1\u20099.8 to 16.3\u2009\u00b1\u20092.8 degrees), mean IMA (from 14.5\u2009\u00b1\u20092.3 to 9.9\u2009\u00b1\u20091.5 degrees), mean DMAA (from 19.4\u2009\u00b1\u20094.4 to 11.4\u2009\u00b1\u20091.9 degrees) and median SP (from 4 (IQR, 3\u20136) to 2 (IQR, 1\u20132) points) was demonstrated in the cohort (p\u2009&lt;\u20090.001 in all cases). There was a strong positive significant correlation between the progression of cases over time and the improvement achieved in terms of SP (R\u2009=\u20090.60, p\u2009=\u20090.003). Conversely, no significant correlation was demonstrated when comparing the improvement obtained in HVA, IMA and DMAA with the number of cases performed (p\u2009&gt;\u20090.05 in all cases). One complication occurred during the first 12 cases (1 transfer metatarsalgia) and 1 during the last 13 (1 intra-operative fracture).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this series, a satisfactory correction of HV after Scarf-Akin osteotomy was obtained without releasing lateral soft-tissues. Beginner surgeons should be aware that restoring sesamoid position may be more challenging as compared to correcting other angles during the first cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level IV, prospective case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-025-05883-z","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T10:36:34Z","timestamp":1746786994000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sesamoid correction achieved during the learning curve for Scarf-Akin osteotomy without lateral soft-tissue release: a single-centre prospective observational study"],"prefix":"10.1007","volume":"145","author":[{"given":"Valentina","family":"Rossi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Hemmati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Magliulo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agostino","family":"Giordano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Izzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Mariconda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessio","family":"Bernasconi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,9]]},"reference":[{"key":"5883_CR1","doi-asserted-by":"publisher","first-page":"1633","DOI":"10.1007\/s00590-018-2235-6","volume":"28","author":"L Galois","year":"2018","unstructured":"Galois L (2018) History of surgical treatments for hallux valgus. Eur J Orthop Surg Traumatol 28:1633\u20131639. https:\/\/doi.org\/10.1007\/s00590-018-2235-6","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"5883_CR2","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1007\/s00264-013-1977-3","volume":"37","author":"JF Doty","year":"2013","unstructured":"Doty JF, Coughlin MJ (2013) Hallux valgus and hypermobility of the first ray: facts and fiction. Int Orthop 37:1655\u20131660. https:\/\/doi.org\/10.1007\/s00264-013-1977-3","journal-title":"Int Orthop"},{"key":"5883_CR3","doi-asserted-by":"publisher","first-page":"857","DOI":"10.3238\/arztebl.2012.0857","volume":"109","author":"N W\u00fclker","year":"2012","unstructured":"W\u00fclker N, Mittag F (2012) The treatment of hallux valgus. Dtsch Arztebl Int 109:857\u2013867. https:\/\/doi.org\/10.3238\/arztebl.2012.0857. (quiz 868)","journal-title":"Dtsch Arztebl Int"},{"key":"5883_CR4","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1007\/s11999-010-1510-6","volume":"469","author":"SP Adam","year":"2011","unstructured":"Adam SP, Choung SC, Gu Y, O\u2019Malley MJ (2011) Outcomes after scarf osteotomy for treatment of adult hallux valgus deformity. Clin Orthop Relat Res 469:854\u2013859. https:\/\/doi.org\/10.1007\/s11999-010-1510-6","journal-title":"Clin Orthop Relat Res"},{"key":"5883_CR5","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.foot.2019.04.002","volume":"40","author":"D Samaras","year":"2019","unstructured":"Samaras D, Gougoulias N, Varitimidis S et al (2019) Midterm experience of Scarf osteotomy as a new technique in a General Orthopaedic Department. Foot (Edinb) 40:68\u201375. https:\/\/doi.org\/10.1016\/j.foot.2019.04.002","journal-title":"Foot (Edinb)"},{"key":"5883_CR6","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.2106\/JBJS.H.00796","volume":"91","author":"R Okuda","year":"2009","unstructured":"Okuda R, Kinoshita M, Yasuda T et al (2009) Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Jt Surg Am 91:1637\u20131645. https:\/\/doi.org\/10.2106\/JBJS.H.00796","journal-title":"J Bone Jt Surg Am"},{"key":"5883_CR7","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1053\/j.jfas.2015.07.001","volume":"54","author":"C Seng","year":"2015","unstructured":"Seng C, Chunyin Ho D, Chong KW (2015) Restoring sesamoid position in scarf osteotomy: a learning curve. J Foot Ankle Surg 54:1089\u20131092. https:\/\/doi.org\/10.1053\/j.jfas.2015.07.001","journal-title":"J Foot Ankle Surg"},{"key":"5883_CR8","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.fcl.2018.01.003","volume":"23","author":"JS Kim","year":"2018","unstructured":"Kim JS, Young KW (2018) Sesamoid position in hallux valgus in relation to the coronal rotation of the first metatarsal. Foot Ankle Clin 23:219\u2013230. https:\/\/doi.org\/10.1016\/j.fcl.2018.01.003","journal-title":"Foot Ankle Clin"},{"key":"5883_CR9","doi-asserted-by":"publisher","first-page":"759","DOI":"10.3113\/FAI.2007.0759","volume":"28","author":"MJ Coughlin","year":"2007","unstructured":"Coughlin MJ, Jones CP (2007) Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int 28:759\u2013777. https:\/\/doi.org\/10.3113\/FAI.2007.0759","journal-title":"Foot Ankle Int"},{"key":"5883_CR10","doi-asserted-by":"publisher","first-page":"247301141983850","DOI":"10.1177\/2473011419838500","volume":"4","author":"JJ Ray","year":"2019","unstructured":"Ray JJ, Friedmann AJ, Hanselman AE et al (2019) Hallux valgus. Foot Ankle Orthop 4:2473011419838500. https:\/\/doi.org\/10.1177\/2473011419838500","journal-title":"Foot Ankle Orthop"},{"key":"5883_CR11","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1053\/j.jfas.2020.09.016","volume":"60","author":"GF Ferreira","year":"2021","unstructured":"Ferreira GF, St\u00e9fani KC (2021) A global bibliometric analysis of hallux valgus research (1999\u20132019). J Foot Ankle Surg 60:501\u2013506. https:\/\/doi.org\/10.1053\/j.jfas.2020.09.016","journal-title":"J Foot Ankle Surg"},{"key":"5883_CR12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0242496","volume":"16","author":"GF Ferreira","year":"2021","unstructured":"Ferreira GF, Borges VQ, Moraes LVM, St\u00e9fani KC (2021) Percutaneous Chevron\/Akin (PECA) versus open scarf\/Akin (SA) osteotomy treatment for hallux valgus: a systematic review and meta-analysis. PLoS ONE 16:e0242496. https:\/\/doi.org\/10.1371\/journal.pone.0242496","journal-title":"PLoS ONE"},{"key":"5883_CR13","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.fas.2023.07.012","volume":"29","author":"AN Baumann","year":"2023","unstructured":"Baumann AN, Walley KC, Anastasio AT et al (2023) Learning curve associated with minimally invasive surgery for hallux valgus: a systematic review. Foot Ankle Surg 29:560\u2013565. https:\/\/doi.org\/10.1016\/j.fas.2023.07.012","journal-title":"Foot Ankle Surg"},{"key":"5883_CR14","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1053\/j.jfas.2019.07.027","volume":"59","author":"E Palmanovich","year":"2020","unstructured":"Palmanovich E, Ohana N, Atzmon R et al (2020) MICA: a learning curve. J Foot Ankle Surg 59:781\u2013783. https:\/\/doi.org\/10.1053\/j.jfas.2019.07.027","journal-title":"J Foot Ankle Surg"},{"key":"5883_CR15","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1053\/j.jfas.2017.01.002","volume":"56","author":"CRJ Jowett","year":"2017","unstructured":"Jowett CRJ, Bedi HS (2017) Preliminary results and learning curve of the minimally invasive chevron akin operation for hallux valgus. J Foot Ankle Surg 56:445\u2013452. https:\/\/doi.org\/10.1053\/j.jfas.2017.01.002","journal-title":"J Foot Ankle Surg"},{"key":"5883_CR16","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1053\/j.jfas.2022.06.005","volume":"62","author":"TL Lewis","year":"2023","unstructured":"Lewis TL, Robinson PW, Ray R et al (2023) The learning curve of third-generation percutaneous chevron and akin osteotomy (PECA) for hallux valgus. J Foot Ankle Surg 62:162\u2013167. https:\/\/doi.org\/10.1053\/j.jfas.2022.06.005","journal-title":"J Foot Ankle Surg"},{"key":"5883_CR17","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1302\/2058-5241.6.210029","volume":"6","author":"H-J Trnka","year":"2021","unstructured":"Trnka H-J (2021) Percutaneous, MIS and open hallux valgus surgery. EFORT Open Rev 6:432\u2013438. https:\/\/doi.org\/10.1302\/2058-5241.6.210029","journal-title":"EFORT Open Rev"},{"key":"5883_CR18","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.fcl.2020.05.002","volume":"25","author":"H Bedi","year":"2020","unstructured":"Bedi H, Hickey B (2020) Learning curve for minimally invasive surgery and how to minimize it. Foot Ankle Clin 25:361\u2013371. https:\/\/doi.org\/10.1016\/j.fcl.2020.05.002","journal-title":"Foot Ankle Clin"},{"key":"5883_CR19","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1016\/j.fas.2022.07.006","volume":"28","author":"A Toepfer","year":"2022","unstructured":"Toepfer A, Str\u00e4ssle M (2022) The percutaneous learning curve of 3rd generation minimally-invasive Chevron and Akin osteotomy (MICA). Foot Ankle Surg 28:1389\u20131398. https:\/\/doi.org\/10.1016\/j.fas.2022.07.006","journal-title":"Foot Ankle Surg"},{"key":"5883_CR20","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1177\/107110070302400304","volume":"24","author":"AM Smith","year":"2003","unstructured":"Smith AM, Alwan T, Davies MS (2003) Perioperative complications of the Scarf osteotomy. Foot Ankle Int 24:222\u2013227. https:\/\/doi.org\/10.1177\/107110070302400304","journal-title":"Foot Ankle Int"},{"key":"5883_CR21","doi-asserted-by":"publisher","DOI":"10.1177\/19386400211029148","author":"JB Jackson","year":"2021","unstructured":"Jackson JB, Kennedy B, Deal P, Gonzalez T (2021) The surgical learning curve for modified lapidus procedure for hallux valgus deformity. Foot Ankle Spec. https:\/\/doi.org\/10.1177\/19386400211029148","journal-title":"Foot Ankle Spec"},{"key":"5883_CR22","doi-asserted-by":"publisher","first-page":"1915","DOI":"10.1007\/s00402-022-04359-8","volume":"143","author":"S Tejero","year":"2023","unstructured":"Tejero S, Gonz\u00e1lez-Mart\u00edn D, Mart\u00ednez-Franco A et al (2023) Intraoperative checking of the first ray rotation and sesamoid position through sonographic assistance. Arch Orthop Trauma Surg 143:1915\u20131922. https:\/\/doi.org\/10.1007\/s00402-022-04359-8","journal-title":"Arch Orthop Trauma Surg"},{"key":"5883_CR23","doi-asserted-by":"publisher","first-page":"6105","DOI":"10.1007\/s00402-023-04868-0","volume":"143","author":"E Palmanovich","year":"2023","unstructured":"Palmanovich E, Ohana N, Tavdi A et al (2023) A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones. Arch Orthop Trauma Surg 143:6105\u20136112. https:\/\/doi.org\/10.1007\/s00402-023-04868-0","journal-title":"Arch Orthop Trauma Surg"},{"key":"5883_CR24","doi-asserted-by":"publisher","first-page":"5753","DOI":"10.3390\/jcm10245753","volume":"10","author":"Y Ezzatvar","year":"2021","unstructured":"Ezzatvar Y, L\u00f3pez-Bueno L, Fuentes-Aparicio L, Due\u00f1as L (2021) Prevalence and predisposing factors for recurrence after hallux valgus surgery: a systematic review and meta-analysis. J Clin Med 10:5753. https:\/\/doi.org\/10.3390\/jcm10245753","journal-title":"J Clin Med"},{"issue":"e20","key":"5883_CR25","doi-asserted-by":"publisher","first-page":"00091","DOI":"10.5435\/JAAOSGlobal-D-20-00091","volume":"4","author":"E Wagner","year":"2020","unstructured":"Wagner E, Wagner P (2020) Metatarsal pronation in hallux valgus deformity: a review. J Am Acad Orthop Surg Glob Res Rev 4(e20):00091. https:\/\/doi.org\/10.5435\/JAAOSGlobal-D-20-00091","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"5883_CR26","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1016\/j.fas.2021.12.008","volume":"28","author":"E Veracruz-Galvez","year":"2022","unstructured":"Veracruz-Galvez E, Perez-Aznar A, Lizaur-Utrilla A et al (2022) Influence of sesamoid position after scarf osteotomy for hallux valgus on patient-reported outcome. A prospective cohor study. Foot Ankle Surg 28:471\u2013475. https:\/\/doi.org\/10.1016\/j.fas.2021.12.008","journal-title":"Foot Ankle Surg"},{"key":"5883_CR27","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.1007\/s00264-013-1959-5","volume":"37","author":"W Schneider","year":"2013","unstructured":"Schneider W (2013) Distal soft tissue procedure in hallux valgus surgery: biomechanical background and technique. Int Orthop 37:1669\u20131675. https:\/\/doi.org\/10.1007\/s00264-013-1959-5","journal-title":"Int Orthop"},{"key":"5883_CR28","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1016\/j.fas.2018.08.009","volume":"25","author":"K Yammine","year":"2019","unstructured":"Yammine K, Assi C (2019) A meta-analysis of comparative clinical studies of isolated osteotomy versus osteotomy with lateral soft tissue release in treating hallux valgus. Foot Ankle Surg 25:684\u2013690. https:\/\/doi.org\/10.1016\/j.fas.2018.08.009","journal-title":"Foot Ankle Surg"},{"key":"5883_CR29","doi-asserted-by":"publisher","first-page":"3997","DOI":"10.1007\/s00402-022-04693-x","volume":"143","author":"A Izzo","year":"2023","unstructured":"Izzo A, Vallefuoco S, Basso MA et al (2023) Role of lateral soft tissue release in percutaneous hallux valgus surgery: a systematic review and meta-analysis of the literature. Arch Orthop Trauma Surg 143:3997\u20134007. https:\/\/doi.org\/10.1007\/s00402-022-04693-x","journal-title":"Arch Orthop Trauma Surg"},{"key":"5883_CR30","doi-asserted-by":"publisher","DOI":"10.1590\/1413-785220233102e265206","volume":"31","author":"GF Ferreira","year":"2023","unstructured":"Ferreira GF, Mattos E, Dinato MC, Santos TFD et al (2023) Can the percutaneous chevron and akin (PECA) technique correct the pronation of the first metatarsal in hallux valgus? Acta Ortop Bras 31:e265206. https:\/\/doi.org\/10.1590\/1413-785220233102e265206","journal-title":"Acta Ortop Bras"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-025-05883-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-025-05883-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-025-05883-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T08:21:48Z","timestamp":1767169308000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-025-05883-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,9]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["5883"],"URL":"https:\/\/doi.org\/10.1007\/s00402-025-05883-z","relation":{},"ISSN":["1434-3916"],"issn-type":[{"type":"electronic","value":"1434-3916"}],"subject":[],"published":{"date-parts":[[2025,5,9]]},"assertion":[{"value":"6 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"284"}}