Correction of hallux valgus by scarf osteotomy – a clinical and radiographical review of 175 cases

Abstract

The paper elaborates on scarf osteotomy in the treatment of hallux valgus deformity. The study evaluates 175 isolated scarf osteotomies of the first metatarsal (with/without the Akin procedure) performed by one surgeon. Radiological (intermetatarsal angle-IMA, hallux valgus angle-HVA, distal-metatarsal articular angle-DMAA, proximal-to-distal phalangeal-articular angle-PDPAA, translation of diaphysis and sesamoid position) and clinical (Foot and Ankle Disability Index - FADI and the American Orthopedic Foot and Ankle Score - AOFAS) evaluation was done before and after treatment. The follow-up was from 1 to 10 years. HVA decreased 24°, from 32°±8,8(16°-60°) to 8°±7,4(- 27°-32°), IMA decreased 11°, from 15°±3,7(16°-31°) to 4°±2,4(0°-13°), DMAA for 12°-from 17° to 5°, PDPAA for 5°-from 5° to 0° and sesamoid position from 5(2-7) to 1(1-7). The first metatarsal translation was 58%±14,5(17%-94%). FADI enlarged from 65±18.2(26-99) to 95±9,7(45-100) and AOFAS from 76±9,to 6(47-98) 96±6,9(72-100). All differences were significant (p<0,05). Recurrence was 4,6%, iatrogenic hallux varus 6,3%, symptomatic screw 9%, transfer metatarsalgia 2,3%, troughing 2,9% superficial wound infection 1,1%, and postoperative hypesthesia 1,1%. Scarf osteotomy is a reliable and safe procedure for the correction of moderate to severe hallux valgus deformities. A relatively long learning curve is a burden with solvable complications.

Keywords

• scarf osteotomy
• hallux valgus
• first metatarsal osteotomy
• scarf learning curve