Moderate to Severe Hallux Valgus Deformities. Surgical treatment with SCARF Osteotomy Technique.

Abstract

Introduction; Many procedures are described in the literature for the surgical management of hallux valgus. There are over 130 surgical procedures described. There is ever rising enthusiasm among orthopedic surgeons regarding diaphyseal osteotomy ever since Burutaran described the procedure in 1973. We report our experience of treating severe cases of Hallux Valgus deformity with a SCARF osteotomy at the last three years follow-up, at patients diagnosed and operated in the University Hospital of Trauma, from January 2015 - February 2018. The technique we are presenting, provides the correction of moderate to severe hallux valgus deformities.
 Material and Methods: Correction of hallux valgus deformities was achieved using a Z step osteotomy cut to realign the first metatarsal bone. A retrospective analysis was undertaken in 38 consecutive patients (54 feet). All results were analyzed by clinical examination, a questionnaire including the AOFAS forefoot score, modified, and plain roentgenograms.
 Results: Hallux valgus and intermetatarsal angle improved at mean 19.6° and 6.9°, respectively. Mean forefoot score improved from 50.1 to 91 points out of 100 possible points. Satisfactory healing time was expressed by an average return back to their attitude of 6-12 weeks, without including physiotherapy. Persistence or recurrence of hallux valgus was seen in 3 patients (8%). The complication rate was 5.4% including superficial wound infection, atrophy of the muscles, traumatic dislocation of the distal fragment.
 Conclusion: Scarf osteotomy is a powerful and versatile procedure to correct hallux valgus deformity, and provides a predictable and satisfying result. Scarfs are not considered as a single osteotomy but as a combination of several procedures and displacement in several planes are possible.