Early results of Scarf osteotomies using differentiated therapy of hallux valgus

Abstract

Summary The differentiated therapy of the hallux valgus includes correction of the varus deformity of the first metatarsal to reduce the intermetatarsal angle. Subcapital osteotomies allow only a small correction of the intermetatarsal angle and may lead to head necrosis of the first metatarsal, whilst proximal correction often has to be fixed with plaster. The Scarf osteotomy represents an alternative operating method which guarantees primary loading stability. The Scarf procedure is an osteotomy of the first metatarsal shaft in a Z-fashion. After parallel and lateral displacement of the distal-plantar fragment osteosynthesis is carried out using two cannulated titanium screws. In addition the pseudoexostosis can be resected, the soft tissue operation and the release of the adductor tendon can be carried out. For this study 53 cases (49 patients) of Scarf osteotomy were evaluated. The follow-up, on average for 1.2 years, included physical examination, radiographs and a podogram. In comparison with the preoperative state a reduction in subjective complaints of up to 74% was obtained. The average improvement of the hallux valgus angle was from 43° to 23° and the intermetatarsal angle was reduced on average from 16° to 8°. The Scarf osteotomy is a technically demanding operation to correct first metatarsal varus deformity. As a matter of principle it should be combined with operation on the soft tissue and release of the adductor tendon. An intermetatarsal angle from 12° to 20° has been the indication for this operation. The major advantage of this method is the primary loading stability which enables early mobilisation. Furthermore, there is the possibility of first metatarsal shortening or lengthening to correct the alignment. Additionally, there is the possibility of a precise change of the metatarsal head position.