The “Scarf” Osteotomy for the Correction of Hallux Valgus

Abstract

Correction of symptomatic valgus deformities. A hallux valgus in which the pathologic intermetatarsal angle I–II can be fully corrected by a lateral shift of the metatarsal head not exceeding two thirds of its width. Hypermobility of the first ray. Osteoporosis. Osteoarthritis of the first metatarsophalangeal joint. Medial longitudinal incision extending from the first metatarsophalangeal joint to the midportion of the metatarsal. Tenotomy of the abductor hallucis longus tendon, and lateral longitudinal incision of the metatarsophalangeal joint capsule to allow complete repositioning of the metatarsal head over the sesamoid bones. Z-shaped osteotomy in the mediolateral plane of the distal two thirds of the first metatarsal. Lateral shift of the distal fragment to reduce the intermetatarsal angle to a physiologic one. A pathologic distal metatarsal articular angle can be corrected simultaneously by rotating the distal fragment medially. Medial metatarsophalangeal capsulorrhaphy. Between October 1995 and July 1998, 73 Scarf osteotomies were performed in 57 patients and followed up clinically and radiologically for an average of 23 (12–45) months. The average intermetatarsal angle I–II was reduced from 12° to 6° and the first metatarsophalangeal angle from 27° to 11°. Patient’s satisfaction assessed in a visual 0–10 analog scale (10 points representing complete satisfaction) reached a mean value of 9.2 points. Three patients would not undergo the operation again (one bilateral severe undercorrection, one painful osteoarthritis of the first metatarsophalangeal joint, and one overcorrection).