Scarf osteotomy for correction of hallux valgus. Historical perspective, surgical technique, and results

The Scarf osteotomy has proven to be a versatile and powerful procedure to correct various degrees of hallux valgus deformity. Through modifications of bone-cut lengths and in combination with a phalangeal osteotomy, most hallux valgus deformities can be addressed. In cases of extreme hypermobility of the first ray or arthrosis of the first metatarsocuneiform joint, the Lapidus operation may be more appropriate. Hallux valgus rigidus or hallux valgus with severe rheumatoid joint disease usually requires alternative procedures. The results of the Scarf osteotomy compare favorably with the results reported for other popular bunion surgeries. When choosing a procedure, the clinician should consider that the Scarf osteotomy allows the patient to ambulate postoperatively without a cast or the use of crutches, to return to bathing and a closed athletic shoe in one week, and to have bilateral surgery, which maintains cost-effectiveness and returns the patient to his or her desired lifestyle more quickly. It has been said that surgery is both a science and an art. The author often believes that bunion surgery is more art than science, hence the success of so many procedures in one surgeon's hands and the failure in another's hands. The Scarf bunionectomy is a technically demanding procedure that has a large learning curve. Once mastered, however, the Scarf bunionectomy can provide a predictable and satisfying outcome for both patient and foot surgeon.     

Scarf osteotomy for correction of hallux valgus. Surgical technique and results as compared to distal chevron osteotomy

With the Scarf osteotomy, a good correction of moderate hallux valgus can be obtained, comparable to the distal or proximal Chevron or crecentic osteotomy. Correction of the IMA averages between 5 degrees to 6 degrees. When used in combination with an adductor release and proximal phalangeal osteotomy, the indication can be extended to severe hallux valgus deformities as long as there is no arthrosis at the MTP joint. The Scarf osteotomy, however, is certainly a more extensive surgical procedure, with a longer learning curve than a distal Chevron osteotomy. With more than 1000 Scarf procedures performed, the author has not encountered one delayed union, even in osteoporotic bone, or an avascular necrosis. In two cases a stress fracture was encountered in the first 3 months after surgery, but these healed uneventfully with partial weight bearing for 5 weeks.     

Early outcome of correction of hallux valgus with the Scarf osteotomy

INTRODUCTION: Aim of this study is to analyze complications as well as clinical and radiological results of the scarf osteotomy for the correction of hallux valgus. PATIENTS AND METHODS: Between 1994 and 1998 we performed a scarf osteotomy for the correction of hallux valgus in 45 cases. Indication was a symptomatic hallux valgus with an increased first intermetatarsal angle (IMA). Fixation of the osteotomy was performed with two 2.3 mm mini screws made of titaneum. Mobilisation was allowed with full weight bearing with a fore foot relief orthesis. Clinical results were valued with the fore foot scoring system (ffss). The determination of the IMA and hallux valgus angles (HVA) was performed with weight bearing d.p. radiographs. RESULTS: All osteotomies healed within the first 6 postoperative weeks. Removal of the screws was not necessary in any case. The preoperative ffss was 16.2 points. At the last follow up (16 month after surgery) the average value of the ffss was 59.1 points. Three patients reached a value below 35 points, two of them suffered from a rheumatic disease. Twenty patients assessed the cosmetic result as excellent, 16 as good, 4 as satisfactory and one as poor. The average IMA could be reduced significantly from 20.2 to 10.3 degrees. The HVA could be lowered from 37.5 to 20.9 degrees. In patients with an IMA of more than 20 degrees the HVA could be reduced to 23.1 degrees in contrast to 18.3 in patients with an IMA of less than 20 degrees. DISCUSSION: The scarf osteotomiy is a surgical procedure for the correction of hallux valgus due to increased IMA which is appropriate in patients younger than 50 years and older than 50 years. In cases of IMA more than 20 degrees correction of IMA and HVA was unsatisfactory.     

The Scarf first metatarsal osteotomy in the correction of hallux valgus deformity

The correction of hallux valgus has been dramatically improved by the scarf 1^st metatarsal osteotomy, which brings great versatility for covering all the indications. Its strong fixation allows an early functional recovery; the long-term follow-up confirms the reliability of this procedure, which can be combined with other osteotomies and soft tissue procedures. However, the surgeon has to determine pre and intraoperatively the correction that has to be applied; this technique is not difficult but has to be performed accurately. This is the interest of this article, which emphasizes the technical features that have to be applied.     

Shortening Scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome?

BackgroundTranslation and shortening of Scarf osteotomy allows correction of severe hallux valgus deformity. Shortening may result in transfer metatarsalgia.AimTo evaluate outcome of patients undergoing shortening Scarf osteotomy for severe hallux valgus deformities.Materials and MethodsFifteen patients (20 feet, mean age 58 years) underwent shortening Scarf osteotomy for severe hallux valgus deformities. Outcomes were pre and postoperative AOFAS scores, IM and HV angles, patient satisfaction.ResultsMean follow-up was 25 months (range 22–30). The IM angle improved from a median of 18.60 (range 13.4–26.20) preoperatively to 9.70 (range 8.0–13.70) postoperatively (8.9; 95% CI = 7.6–10.3; p < 0.001). The HV angle improved from a mean of 43.2 (range 27.4–68.2) preoperatively to 13.6 (range 3.0–37.4) postoperatively (29.6; 95% CI = 26.1–33.2; p < 0.001).The median AOFAS score improved from 29.2 (range 14–60) preoperatively to 82.2 (range 55–100) postoperatively (53.0; 95% CI = 48.0–58.5; p < 0.001). All patients rated their satisfaction as either satisfied or very satisfied. None had symptoms of transfer metatarsalgia at final follow-up. All osteotomies united.ConclusionsShortening Scarf osteotomy is a viable option for treating severe hallux valgus deformities with no transfer metatarsalgia.     

Scarf osteotomy for hallux valgus. A prospective clinical and pedobarographic study

We prospectively reviewed 24 patients (35 feet) who had been treated by a Scarf osteotomy and Akin closing-wedge osteotomy for hallux valgus between June 2000 and June 2002. There were three men and 21 women with a mean age of 46 years at the time of surgery. The mean follow-up time was 20 months. Our results showed that 50% of the patients were very satisfied, 42% were satisfied, and 8% were not satisfied. The mean American Orthopaedic Foot and Ankle Society score improved significantly from 52 points pre-operatively to 89 at follow-up (p < 0.001). The intermetatarsal and hallux valgus angles improved from the mean pre-operative values of 15 degrees and 33 degrees to 9 degrees and 14 degrees, respectively. These improvements were significant (p < 0.0001). The change in the distal metatarsal articular angle was not significant (p = 0.18). There was no significant change in the mean pedobarographic measurements of the first and second metatarsals after surgery (p = 0.2). The mean pedobarographic measurements of the first and second metatarsals at more than one year after surgery were within the normal range. Two patients had wound infections which settled after the administration of antibiotics. One patient had an intra-operative fracture of the first metatarsal and one required further surgery to remove a long distal screw which was irritating the medial sesamoids. We conclude that the Scarf osteotomy combined with the Akin closing-wedge osteotomy is safe and effective for the treatment of hallux valgus.     

Distal osteotomy for bunionectomy and hallux valgus correction.

Distal osteotomies are the original osteotomies performed in the first metatarsal for bunion surgery. Many of these can be fashioned to improve an abnormal DMAA. Correction of an abnormally wide first-second IM angle is a goal of the newer procedures. Lateral transposition at the osteotomy site first performed by Mitchell helps accomplish this goal. The chevron modification improves stability and offers sufficient correction for mild-to-moderate deformities. Fixation is recommended after metatarsal osteotomy. The distal chevron procedure has been associated with lower degrees of correction, but the risk of transfer metatarsalgia is minimized. Shortening is less likely compared with some distal osteotomies but can occur. Advanced age is not a contraindication for distal metatarsal osteotomy. Avascular necrosis is highly unusual after this procedure.     

Scarf osteotomy for hallux valgus repair: the dark side

HYPOTHESIS/PURPOSE: The Scarf osteotomy has gained popularity as treatment of choice in parts of Europe and is based on sound structural principles. The excellent results reported by others could not, however, be reproduced by the author and the results are presented. METHODS: From January 1997 to June 1997 the Scarf osteotomy was selected in 20 consecutive patients (12 female and eight male patients, ages 18 to 60, mean: 41 years) with moderate metatarsus primus varus (IMA 13 to 20 degrees) and hallux valgus deformities (less than 40 degrees). The AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale, visual analog scale and patient satisfaction were monitored prior to surgery, six and 12 months post-op. The patients were treated in a short leg cast, non-WB for two weeks followed by four weeks partial WB in a cast shoe. Routine post-bunion rehabilitation followed once the radiological and clinical diagnosis of healing was made. RESULTS: Multiple complications were encountered. The most common was "troughing" of the metatarsal with loss of height. This occurred in seven patients (35%). Other complications include delayed union (5%), rotational malunion (30%), proximal fracture (10%), infection (5%) and early recurrence of deformity in 25%. All 20 patients were available for follow-up at six months, and 19 of 20 at 12 months. The AOFAS score pre-op was a mean of 53. At six months a mean of 54 (19 to 69) and at 12 months 62 (24-100). Forty-five percent (9/20) were unsatisfied at one year and would not recommend the surgery to a friend. CONCLUSIONS/SIGNIFICANCE: The Scarf osteotomy has multiple potential pitfalls and should probably be reserved for moderate bunions in young people with good bone quality. There are multiple potential problems and the salvage of a failed Scarf osteotomy is difficult.     

Scarf osteotomy for hallux valgus—is an Akin osteotomy necessary?

Scarf osteotomy has gained popularity as one of the recommended procedures for moderate to severe hallux valgus. An Akin osteotomy may also allow additional correction but carries its own complications. The aim of this study was to assess the need for Akin osteotomy with a scarf procedure.We reviewed our results of scarf osteotomy with and without Akin in 69 patients with 99 procedures. Sixteen patients (25 feet) had an Akin osteotomy with a scarf procedure. Radiological results were analysed by measuring the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and the position of the tibial sesamoid. AOFAS scores were collected prospectively. Patient satisfaction was determined by whether or not they would have the operation again for a similar condition.The mean age of the patients was 48.3 years (range 12–76) with a mean follow-up of 21 months. The mean improvement for the whole group in the IMA was from 15.8 to 7.9, HVA from 37.9 to 16.4 and DMAA from 19 to 9.9 was noted. The position of sesamoids improved from a mean of 5.8 to 2.3. The results were similar in both the groups and no significant difference was noted. AOFAS score improved from a mean of 53.6 preoperatively to 92.5 postoperatively. Three patients in the scarf group needed an Akin osteotomy as a revision procedure.Scarf osteotomy alone may be an effective procedure for moderate to severe hallux valgus. An Akin osteotomy may be indicated if residual hallux valgus is noted during surgery.     

Scarf截骨联合软组织平衡松解治疗重度拇外翻

目的：探讨Scarf截骨联合软组织平衡治疗重度拇外翻的手术疗效。方法：回顾性分析2019年6月至2021年6月采用Scarf截骨联合软组织平衡手术治疗的38例（50足）重度拇外翻患者的临床资料,男6例（8足）,女32例（42足）;年龄29～64(54.7±6.8)岁;左侧26足,右侧24足;病程5～23(12.4±3.9)年。比较手术前后拇外翻角（hallux valgus angle,HVA）、第1、2跖骨间角（intermetatarsal angle,IMA）、跖骨远端关节面角（distal metatarsal articular angle,DMAA）,观察术后并发症发生情况。术前和末次随访时采用美国足与踝关节协会（American orthopedic foot ankle society,AOFAS）评分评价前足功能恢复情况,采用视觉模拟评分法（visual analogue scale,VAS）评价患者疼痛缓解程度。结果：38例患者（50足）均获随访,时间15～23(18.3±3.2)个月。HVA、IMA、DMAA术前分别为（44.61±3.92）°、（18.74±2....     

(足母)展肌腱转位联合Scarf截骨治疗中重度(足母)外翻

[目的]介绍(足母)展肌腱转位联合Scarf截骨治疗中重度(足母)外翻的手术技术。[方法] 2017年1月～2017年09月,采用Scarf截骨联合(足母)展肌腱转位治疗中、重度(足母)外翻患者32例(45足)。倒"L"形切开关节囊,显露第一跖骨内侧骨赘、矢状沟和踇展肌。自(足母)展肌腱止点处切取约1/3～1/2宽度(足母)展肌腱,切除骨赘,充分松解外侧关节囊及(足母)收肌。第一跖骨行Scarf截骨,向外侧推移第一跖骨远端,纠正增大的IMA,修整多余骨皮质,将自体骨回植于截骨间隙,防止第一跖骨头上抬,两枚螺钉固定。维持(足母)趾于正确的生理位置,缩紧缝合关节囊,将(足母)展肌断端缝合于关节囊背侧。[结果]本组患者32例共45足,第一跖骨截骨均在8周内愈合,未出现内固定松动、骨折延迟愈合及第一跖骨头坏死等并发症。末次随访时所有患者Maryland评分和影像测量的IMA、HVA、PASA均较术前显著改善,差异有统计学意义(P0.05),尽管两时间点间第一跖趾关节活动度无显著变化(P0.05)。[结论]应用(足母)展肌腱转位联合Scarf截骨可有效矫正中重度(足母)外翻畸形,且未见手术相关并发症发生。     

Scarf截骨治疗躅外翻的短期疗效分析

背景：拇外翻为足踝外科常见病、多发病,目前以各种手术治疗为主,术后效果及复发率有较大差异。目的：探讨Scarf截骨联合其他手术方式治疗中、重度拇外翻的短期疗效。方法：2008年7月至2010年6月,采用Scarf截骨治疗中、重度坶外翻患者33例（41足）,男4例（4足）,女29例（37足）;年龄24-69岁,平均51．7岁。在Scarf截骨的基础上部分患者联合第一跖趾关节骨赘切除、软组织松解及拇趾近节趾骨Akin截骨等手术方式。采用美国足踝外科协会（American Orthopedic FootandAnkle Society,AOFAS）Maryland拇跖趾关节评分系统进行疗效评估。随访时摄足负重位X线片并测量拇外翻角（halluxvalgusangle,HVA）和第一、二跖骨间角（intermetatarsalangle．IMA）。结果：所有患者均获随访,时间12-36个月,平均20．4个月。HVA由术前32．78。矫正至10．18°,IMA由术前11．57。矫正至6．26。。Maryland拇跖趾关节评分：90-100分28足（68．3％）,80-89分11足（26．8％）,70-79分2足（4．9％）,优良率为95．1％（39／41）。结论：Scarf截骨术具有较好的自身稳定性,纠正畸形能力强,愈合快,坚固的内固定可使患者早期下地活动,并发症相对较少,联合其他手术方式是治疗中、重度拇外翻的理想方法。     

The chevron osteotomy for correction of hallux valgus

Introduction The chevron osteotomy has become widely accepted for correction of mild and moderate hallux valgus deformities. The purpose of this study was to present the evolution of the chevron osteotomy at one institution over a period of 12 years. Methods Between April, 1991 and September, 1992, fifty-two consecutive patients with mild to moderate hallux valgus deformity underwent sixty-six distal chevron osteotomies at our institution. This was followed by 85 patients with 100 feet in the period from 1992 to 1995 and a group of 45 patients with 55 feet from 1994 to 1995. The final patient group included 61 patients with 89 feet operated from 2000 to 2002. Conclusion The chevron osteotomy is a reliable technique to correct hallux valgus deformities. Our recommendation after reviewing the results of the various modifications of the chevron technique revealed that the addition of a lateral release and a screw fixation will lead to the most reliable results.     

Ludloff截骨治疗拇外翻疗效观察

<正>2010年1月~2013年8月,我科收治36例中、重度拇外翻患者,均采用Ludloff截骨配合软组织手术,疗效满意,报道如下。1材料与方法1.1病例资料本组36例,男2例,女34例,年龄40~65岁。术前X线检查:拇外翻角25.8°~38.6°,第1、2跖骨间夹角15°~21.5°。跖趾关节无退行性改变。内侧跖楔关节无明显的不稳定。1.2治疗方法采用踝神经阻滞麻醉。于第1、2跖骨头趾蹼背面近侧2~3 cm     

改良Scarf截骨术治疗拇外翻的临床疗效

目的探讨改良Scarf截骨术治疗拇外翻的临床疗效。方法应用改良Scarf截骨术治疗拇外翻患者68例(92足),比较手术前后拇外翻角(HVA)、第1、2跖骨间角(IMA)及远端关节面固有角(DMAA)的变化。末次随访时,采用AOFAS评分标准评价疗效。结果68例患者均获得随访,时间9~12个月。末次随访时,HVA、IMA、DMAA均较术前显著减小(P<0.01),AOFAS评分较术前显著升高(P<0.01),疗效优、良、可分别为82、5、5足,治疗优良率为94.6%。结论改良Scarf截骨术是矫正拇外翻畸形的可靠技术,纠正畸形效果满意,能有效缓解疼痛。     

Percutaneous distal metatarsal osteotomy for correction of hallux valgus

BACKGROUND: Distal osteotomy of the first metatarsal is indicated for the surgical treatment of mild-to-moderate hallux valgus deformity. The aim of this study was to evaluate the results of a subcapital distal osteotomy of the first metatarsal with use of a percutaneous technique. METHODS: From 1996 to 2001, 118 consecutive percutaneous distal osteotomies of the first metatarsal were performed for the treatment of painful mild-to-moderate hallux valgus in eighty-two patients. The patients were assessed with a clinical and radiographic protocol at a mean of 35.9 months postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale was used for the clinical assessment. RESULTS: The patients were satisfied following 107 (91%) of the 118 procedures. The mean score on the AOFAS scale was 88.2 +/- 12.9 points. The postoperative radiographic assessments showed a significant change (p < 0.05), compared with the preoperative values, in the mean hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, and sesamoid position. The valgus deformity recurred after three procedures (2.5%), the first metatarsophalangeal joint was stiff but not painful after eight (6.8%), and a deep infection developed after one (0.8%). The infection resolved with antibiotic therapy. CONCLUSIONS: The percutaneous technique proved to be reliable for the correct execution of a distal linear osteotomy of the first metatarsal for the correction of a painful mild-to-moderate hallux valgus deformity. The clinical results appear to be comparable with those obtainable with traditional open techniques, with the additional advantages of a minimally invasive procedure, a substantially shorter operating time, and a reduced risk of complications related to surgical exposure.     

New modified technique of osteotomy for hallux valgus

PURPOSE: To improve the technique of osteotomy for hallux valgus (bunion). METHODS: 38 cases of a new modified osteotomy procedure for hallux valgus were performed for 22 patients (21 women and one man). During a 3-year (range, 2-5 years) follow-up, the patients underwent physical examination; and their American Orthopedic Foot and Ankle Society hallux-metatarso-phalangeal-interphalangeal scale scores and standard foot radiographic measurements were recorded. RESULTS: 20 of the 22 patients (38 cases) had no pain, achieved good cosmesis, and were completely satisfied with the results of the operation. The remaining 2 patients had occasional mild discomfort. The mean hallux-metatarso-phalangeal-interphalangeal scale score was 93 points (range, 78-100 points). The mean preoperative and postoperative metatarsophalangeal angles were 34 degrees and 11 degrees, respectively. The mean postoperative reduction of the intermetatarsal angle and metatarsophalangeal angle were 6 degrees and 23 degrees, respectively. CONCLUSION: The new technique of osteotomy achieved even greater stability and accurate correction of the deformity in our 38 cases. Furthermore, it was more effective than conventional 'chevron' osteotomy in terms of correction of the deformity. Therefore, it should be used more widely.     

Chevron osteotomy for hallux valgus.

The chevron osteotomy for realignment of the first metatarsal head in metatarsus primus varus deformity has been utilized at the Mayo Clinic since 1976 on 26 feet (18 patients). Follow-up evaluation disclosed excellent relief of pain, good cosmetic correction, and overall patient satisfaction. Radiographic evaluation demonstrated reduction in the angle between the phalanx and the metatarsal bone of the great toe as well as narrowing of the forefoot with a decreased angle between the first and the second metatarsal bones. The stability of the osteotomy, the technical ease, and the absence of secondary difficulties such as transfer metatarsalgia make this procedure preferable when osteotomy of the distal portion of the first metatarsal bone is used for correction of moderate deformity.     

旋转Scarf截骨术治疗拇外翻合并第1跖骨旋转

目的：探讨旋转Scarf截骨术治疗拇外翻（hallux valgus,HV）合并第1跖骨旋转的临床疗效。方法：自2018年1月至2019年10月采用旋转Scarf截骨术治疗35例（40足）HV合并第1跖骨旋转畸形患者,其中男5例,女30例;年龄25～76(40.32±5.43)岁。观察并比较手术前后拇外翻角（hallux valgus angle,HVA）,第1、2跖骨间角（intermetatarsal angle,IMA）,第1跖骨远端关节面角（distal metatarsal articular angle,DMAA）,第1跖骨长度（the first metatarsal length,FML）,术后采用美国矫形骨科学会足踝外科学组（American Orthopedic Foot and Ankle Society,AOFAS）拇趾-跖趾-趾间关节评分和疼痛视觉模拟评分（visual analogue scale,VAS）系统进行功能评价。结果 ：35例（40足）均获得随访,时间12～36(14.35±3.62)个月。HVA、IMA和DMAA分别由术前的（36.32±4.5...