One-Year Comparative Outcomes of Scarf/Akin Osteotomy Versus Modified Lapidus Procedure in the Correction of Moderate to Severe Hallux Valgus

BACKGROUND: Hallux valgus is a common forefoot deformity. Both Scarf/Akin osteotomy and the modified Lapidus procedure (MLP) are established surgical options for moderate to severe cases, but few studies directly compare outcomes. METHODS: A retrospective cohort study of patients undergoing Scarf/Akin osteotomy or MLP between 2019 and 2020 was performed. Patient-reported outcomes (Manchester Oxford Foot Questionnaire (MOXFQ), Foot and Ankle Outcome Scores (FAOS), EQ-5D-5L) and radiographic measures (hallux valgus angle (HVA), intermetatarsal angle (IMA)) were compared at a minimum 12-month follow-up. RESULTS: Thirty-one patients were included (22 Scarf/Akin, nine MLP; mean age 58 years; 23 female patients). Patients in the Scarf group reported less difficulty with walking/standing (MOXFQ, p = 0.042) and higher activities of daily living (FAOS ADL, p = 0.049). EQ-5D demonstrated trends toward fewer mobility and self-care problems in Scarf patients, but differences were not statistically significant. Radiographically, MLP achieved greater correction of HVA (p = 0.011) and IMA (p < 0.001). CONCLUSION: Both procedures significantly improved outcomes at one year. Scarf/Akin osteotomy was associated with better short-term functional recovery, while MLP achieved superior radiographic correction. Procedure choice may be individualized based on patient factors and deformity severity.