Scarf osteotomy outcomes

NewsBot · Apr 15, 2006

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Scarf osteotomy for the treatment of forefoot deformity.
Acta Chir Orthop Traumatol Cech. 2006;73(1):18-22[Article in Czech]

PURPOSE OF THE STUDY The outcome of surgical treatment in hallux valgus is sometimes unsatisfactory for both the patient and the surgeon. The valgus position of the big toe in the metatarsophalangeal joint is associated with a deviation to varus of the first metatarsal, resulting in the space between the first and second metatarsals called the intermetatarsal (IMT) angle. In most patients the angle is between 10 and 20 degrees. These patients were indicated for scarf osteotomy as this method has been reported to achieve good outcomes. The results are compared with the relevant literature data on foot osteotomy.

MATERIAL Our group involved 62 scarf osteotomies carried out on 49 patients who were followed up for an average of 18 months (range, 6-36 months). Three patients underwent surgery on both feet in one stage, five had bilateral surgery in two stages. The average pre-operative IMT angle was 16 degrees (range, 9-21 degrees) and the average hallux valgus angle was 37 degrees.

METHODS The patients were indicated for surgery on the basis of subjective complains and weight-bearing radiographs. Scarf osteotomy was performed by the Barouk technique. From a signle incision in the first intermetatarsal space, the lateral articular capsule was released, adductor tendon was dissected and sesamoid bones were reduced. The first metatarsal was exposed from an incision along its medial axis, the bunion was excised and Z-osteotomy of the metatarsal was performed. The distal fragment was shifted laterally, fixed with two 3.5 mm Poldi screws, and the capsule was closed under tension with transosseal suture. If necessary, an additional procedure on the big toe phalanges or osteotomy of the other metatarsals are carried out.From the second post-operative day the patients were allowed to walk on the heel, after removal of sutures they walked wearing a special sandal and, from the third week onwards, full weight-bearing was allowed. The average hospital stay lasted 4 days. The evaluation of post-operative results was based on radiograms, subjective feelings of the patients and clinical assessment of the range of big toe motion.

RESULTS Out of 62 operations carried out on 49 patients (average age, 41.5 years), 23 were performed on the right and 23 on the left foot; bilateral surgery was carried out in three patients in one stage and in five patients in two stages. Simultaneously, the Weil osteotomy was performed on six feet, Akin osteotomy of the big toe phalanges on five feet, Braggard surgery of the second toe on three feet, and scarf osteotomy of the fifth metatarsal on three feet. All feet were indicated for scarf osteotomy because of pain and, in 56 feet, also esthetic reasons were involved. The patients' subjective post-operative assessments were as follows: satisfaction with the outcome in 58 feet, pain associated with tight shoes in two feet, pain while walking in six feet, and dissatisfaction with the big toe shape in one patient.The average IMT angle of 16 degrees and hallux valgus angle of 37 degrees on the pre-operative radiograms showed improvements to 9 degrees and 18 degrees, respectively, on the post-operative X-ray. The sesamoid bones were reduced in all cases. After surgery the average range of motion was restricted as follows: plantar flexion by 7 degrees (to 23 degrees) and dorsal flexion by 6 degrees (to 54 degrees). The complications included one fracture of the head requiring osteosynthesis, one failure of fixation with repeat valgus osteotomy, three cases of insufficient correction of a valgus position that had to be treated by additional osteotomy of the first toe phalanges.

DISCUSSION Out of other types of osteotomy (Funk, Dega, spike osteotomy), outcomes similar to scarf osteotomy have been achieved only by the Austin procedure. However, in this, shifting of the distal fragment is limited and the results show that the Austin method should be preferred in deformities with an IMT angle of about 10 degrees. Scarf osteotomy in addition allows for early weight-bearing, does not produce shortening of the first metatarsal but permits its elongation and elevation by oblique osteotomy, if necessary. It can also be used for the fifth metatarsal. The drawbacks include a more complicated surgical technique and higher risk of complications; shifting of the distal fragment is also limited and, for this reason, scarf osteotomy is not effective in deformities with an IMT angle higher than 20 degrees.

CONCLUSIONS Scarf osteotomy is an effective procedure for a moderate valgus deformity of the big toe with an IMT angle between 10 and 20 degrees. It permits early weight-bearing of the treated extremity. It requires exact pre-operative planning and strict adherence to the operative technique.
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NewsBot · Aug 15, 2006

Scarf Osteotomy

Pedographic, Clinical, and Functional Outcome after Scarf Osteotomy.
Lorei TJ, Kinast C, Klarner H, Rosenbaum D.
Clin Orthop Relat Res. 2006 Jul 10;

The aim of this study was to investigate whether a Scarf osteotomy for hallux valgus correction achieves a good functional restoration with pain reduction, improved mobility, and hallux loading. Therefore, we prospectively studied 32 patients who had a Scarf osteotomy for unilateral hallux valgus. We performed clinical, radiographic, and pedographic evaluations after a mean followup of 33 months to assess clinical and functional outcomes. The mean postoperative American Orthopaedic Foot and Ankle Society score was 89 points. The hallux valgus angle improved from 32.5 degrees to 6.2 degrees , and the intermetatarsal angle improved from 15.5 degrees to 6.6 degrees . The postoperative pedographic patterns showed that the maximum force and impulse decreased under the lateral forefoot and increased under the medial forefoot and hallux. The first ray became more important in the roll-over process. There was a moderate relationship between satisfaction and postoperative hallux valgus angle. The Scarf osteotomy improved the pain situation, the walking capacity, and led to an improved contribution of the hallux in the roll-over process. Therefore, this surgical procedure restores forefoot function and normalizes plantar pressure patterns.

Level of Evidence: Prognostic study, Level II (retrospective study).
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W J Liggins · Aug 17, 2006

Scarf osteotomy

What is the Barouk technique? Is that the one taught to Barouk by Lowell Weil?

The paper discusses only the displacement method, not the rotational technique in which considerably greater reduction in I.M. angle can be achieved. Good to see a paper on the subject though.

Bill Liggins

Dieter Fellner · Aug 17, 2006

Barouk

W J Liggins said:

What is the Barouk technique? Is that the one taught to Barouk by Lowell Weil?

The paper discusses only the displacement method, not the rotational technique in which considerably greater reduction in I.M. angle can be achieved. Good to see a paper on the subject though.

Bill Liggins
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Hello Bill

I do not have first hand knowledge of this but talking to those who know Barouk and Scott Weill I am led to believe those surgeons do not like, nor practice, the rotation scarf. Preferring instead the transposition scarf, correction of a very high angle is possible by overlap technique. The overlap can be very aggressive and at times it seems almost as if the medial cortex has been acquainted with the lateral cortex !

Initially sceptical, I have been using this same technique for a while now also. The results can be quite impressive but fixation, without access to the recommended cannulated screw system and / or C-arm, is technically more challenging.

Dieter

W J Liggins · Aug 18, 2006

Scarf osteotomy

Hello Deiter

When I started to use the transpositional technique I found it all too easy to result in 'troughing'. For this reason I tend to use the rotational technique, although a patient recently suffered a fracture of the met. - I gather that this has happened elsewhere; also, I have seen avascular necrosis reported with the rotational scarf, although I have yet to experience this. For lesser I.M. angles, I find Austin/distal L techniques perfectly adequate, bearing in mind that the I.M. angle will reduce approximately 2 degrees, simply by removing the distal/proximal tension, as in a Keller. In situations of 1st met. instablility I will use a Lapidus with or without a distal technique. 'Horses for Courses' I suppose.

I remember Barouk and Weil lecturing to the P.A. many years ago. Barouk was very happy to acknowledge that Weil had introduced him to the scarf and both Barouk and Weil disliked the use of their names used for the techniques ascribed to them. Then, both are excellent foot surgeons but I suppose that is the price of fame!

All the best

Bill Liggins

Dieter Fellner · Aug 18, 2006

Troughing

Bill

From time to time I find troughing can be a problem especially in the older patient with softer bone. If there are signs of this, and I assess this intra-operatively, before finalising fixation, I will use the rotation osteotomy instead.

Your are quite right of course. Horses for courses it is. I remain fond of the Reverdin Green and the many modifications. A most versatile procedure, when indicated.

Increasingly I feel the same about the Scarf osteotomy - incredibly versatile.

Regards

Dieter

NewsBot · Dec 6, 2006

Scarf osteotomy for hallux valgus deformity: an intermediate followup of clinical and radiographic outcomes.
Foot Ankle Int. 2006 Nov;27(11):883-6
Aminian A, Kelikian A, Moen T

BACKGROUND: The scarf osteotomy is a versatile and reproducible procedure for the correction of moderate to severe hallux valgus deformity (intermetatarsal angle 12 to 20 degrees hallux valgus angle 20 to 46 degrees).

METHODS: We evaluated the results of 27 consecutive scarf osteotomies at an average followup of 16.1 months. Radiographic parameters, foot pressure analysis, and AOFAS scores were analyzed before and after surgery.

RESULTS: Hallux valgus angles improved from 34.5 to 16.9 degrees, intermetatarsal angles improved from 15.4 to 10.1 degrees, AOFAS scores improved from 54.5 to 86.5. There was no change between the preoperative and postoperative relative lengths of the first and second metatarsals, defined as the difference between the first and second metatarsal lengths. The measurement was based on the anteroposterior standing radiographs and measured by a line intersecting the midway point at the diaphyseal-metaphyseal junction of the metatarsal and extending from the most proximal to distal aspects of the bone. The angle of Meary (talo-first metatarsal angle) did not change, except in one patient. Foot pressure analysis showed no evidence of transfer metatarsal lesions. The complication rate was 1.1% including superficial infection and recurrence.

CONCLUSIONS: The scarf osteotomy provides a predictable and effective correction of moderate to severe hallux valgus deformities.
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Admin2 · Dec 6, 2006

Related thread:
Mitchel vs Scarf osteotomy

NewsBot · May 24, 2007

Scarf osteotomy in hallux valgus: a review of 72 cases.
Berg RP, Olsthoorn PG, Poll RG.
Acta Orthop Belg. 2007 Apr;73(2):219-23.

The Scarf osteotomy is now widely used for the correction of hallux valgus. The aim of our study was to evaluate the results after Scarf osteotomy considering patient's satisfaction as well as the clinical and radiological results. Between 1996 and 1999, 72 feet underwent a Scarf osteotomy of the first metatarsal and, in 11 feet, an additional Akin osteotomy of the proximal phalanx, for the correction of hallux valgus (55 patients: 49 female, 6 male; mean age: 52 years). The hallux valgus angle improved significantly, from 32 degrees preoperatively to 18 degrees at follow-up (minimal follow-up: 6 years; mean: 7.5 years). A second operation was necessary in two patients because of recurrence of hallux valgus, and a fusion of the first metatarsophalangeal joint was performed in two patients. At the time of latest follow-up 78% of the patients were satisfied or very satisfied with the result. The Scarf osteotomy combined with Akin's closing wedge osteotomy is a safe and effective procedure for the treatment of moderate hallux valgus deformities.
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NewsBot · Jun 15, 2007

Scarf versus chevron osteotomy in hallux valgus: a randomized controlled trial in 96 patients.
Deenik AR, Pilot P, Brandt SE, van Mameren H, Geesink RG, Draijer WF.
Foot Ankle Int. 2007 May;28(5):537-41.

BACKGROUND: The degree of correction of hallux valgus deformity using a distal chevron osteotomy is reported as limited. The scarf osteotomy is reported to correct large intermetatarsal angles (IMA). The purpose of this study was to evaluate if one technique gave greater correction of the IMA and hallux valgus angle (HVA) than the other.

METHODS: After informed consent, 96 feet in 83 patients were randomized into two treatment groups (49 scarf and 47 chevron osteotomies). The results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Valgus Scale and radiographic HVA and IMA measurements.

RESULTS: At 27 (range 23-31) months followup both groups improved. The AOFAS score in the chevron group improved from 48 to 89 points and in the scarf group from 47 to 91 points. In the chevron group the HVA corrected from 30 to 17 degrees, and in the scarf group the HVA corrected from 29 to 18 degrees. In both groups, the IMA was corrected from 13 to 10 degrees. The differences were not statistically significant. Three patients in the chevron group developed a partial metatarsal head necrosis. In the scarf group, four patients developed grade 1 complex regional pain syndrome compared to one patient in the chevron group.

CONCLUSIONS: No differences of statistical significance could be measured between the two groups with respect to the AOFAS score, HVA, and IMA. Although both groups showed good to excellent results, we favor the chevron osteotomy because the procedure is technically less demanding.
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NewsBot · Dec 11, 2007

Complications of first ray osteotomies: a consecutive serie of 475 feet with first metatarsal Scarf osteotomy and first phalanx osteotomy.
Hammel E, Abi Chala ML, Wagner T.
Service d'Orthopédie Traumatologie, Centre Hospitalier de Pau, 4, boulevard Hauterive, 64046 Pau Université
Rev Chir Orthop Reparatrice Appar Mot. 2007 Nov;93(7):710-9.

PURPOSE OF THE STUDY: Available studies on Scarf osteotomies of the first metatarsal (M1) and first phalange (P1) shortening and varus displacement have reported good results, but have have not focused on complications. We reviewed a consecutive series of 475 feet operated on over a five year period. Our goal was to determine the incidence of complications and to compare our data with reports in the literature. We wanted to know if association with Weil osteotomy on the lateral metatarsals affects the rate of complications.

MATERIAL AND METHODS: We used the following inclusion criteria: hallux valgus > 35 degrees , adult subject, with or without impact on the lateral ray, no prior foot surgery, no systemic disease, no other co-morbid condition. We distinguished two groups: group 1 with isolated first ray disease, and group 2 with hallux valgus and lateral metatarsalgia requiring surgery.

RESULTS: We determined the incidence of each complication. Metatarso-phalangeal joint (MTP1) stiffness was the most frequent complication: incidence declined with postoperative time: 41.7% at day 35, 5.7% at day 120. The joint was very stiff with defective pulp weight-bearing in 1.3% of the feet at 12 months. Late wound healing was observed in 5.7% of feet and secondary osteotomy displacement in 1%. Incidence of other complications, including operative site infection, was less than 1%. General complications were: reflex dystrophy (1.3%) and deep vein thrombosis (0.6%). Excepting a longer period of postoperative stiffness, we were unable to identify any change in the rate of postoperative complications in feet with an associated Weil osteotomy of the first ray.

DISCUSSION: Our findings confirm that Scarf M1 osteotomies with varus shortening of P1 generates fewer complications than the techniques used earlier. Certain complications have disappeared: nonunion after M1 and P1 osteotomy, great toe claw, symptomatic iatrogenic hallux valgus. Complications with a very low incidence in all series are: operative site infection, osteonecrosis of the M1 head, fracture of M1 at weight bearing. Notching of the two osteotomy pieces with elevation of the metatarsal head and transfer metatarsalgia has been reported by authors using short diaphyseal osteotomies. A stiff MTP1 remains the most frequent complication. Overtly stiff joints (30% loss of range of motion) were observed in 4.6% of our patients at 12 months; 1.3% had major stiffness (20 degrees extension, 0 degrees plantar flexion). This stiffness has been reported by others using the same technique but the risk factors have not been identified.

CONCLUSION: This prospective work enabled us to establish the rate of secondary complications of first ray surgery for M1 Scarf osteo-tomy and P1 osteotomy. Complications are rare, a further argument favoring use of these osteotomies. This statistical study enables us discuss the risk of complications at the preoperative interview, keeping in mind the specific elements inherent in each particular situation.
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NewsBot · Mar 4, 2008

Restoration and Preservation of First Metatarsal Length Using the Distraction Scarf Osteotomy
Journal of Foot and Ankle Surgery Volume 47, Issue 2, Pages 96-102 (March 2008)

The authors reviewed the records of 8 patients who underwent a distraction scarf osteotomy of the first metatarsal, and report the radiographic outcomes achieved with this procedure. The osteotomy was used to reestablish or maintain the length of the first metatarsal, without the use of a structural bone graft. The osteotomy was used as part of a revisional procedure for a failed bunionectomy in 4 patients. In the remaining patients, the procedure was used to preserve the length of the first metatarsal in conjunction with a Lapidus arthrodesis. The first and second metatarsals were measured radiographically, and the length of the first metatarsal was expressed as a percentage of the length of the second metatarsal. The average proportional increase in first metatarsal length obtained in the patients undergoing correction of the shortened first metatarsal was 7.08%, and the difference between the pre- and postoperative length of the first metatarsal was statistically significant (P = .0013) in these patients. Relative shortening of the first metatarsal was avoided in those patients undergoing distraction scarf osteotomy in conjunction with Lapidus arthrodesis.
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NewsBot · Jul 2, 2008

Scarf osteotomy for the correction of hallux valgus: midterm clinical outcome.
Lipscombe S, Molloy A, Sirikonda S, Hennessy MS.
J Foot Ankle Surg. 2008 Jul-Aug;47(4):273-7

We prospectively reviewed 22 patients (31 feet) who underwent a scarf osteotomy between January 2001 and March 2002. There were 20 females and 2 males. Ages ranged from 35 to 77 years (mean = 57 years). American Orthopedic Foot and Ankle Society (AOFAS) scores improved from a preoperative mean of 47.94 +/- 13.57 and increased significantly to 96.10 +/- 6.15 (P < .01) after 12 months. The hallux valgus angle improved in all patients from a preop mean of 31.4 +/- 8.0 degrees to 11.0 +/- 10.8 degrees at 12 months. The intermetatarsal angle improved from 13.0 +/- 4.2 degrees to 6.1 +/- 3.2 degrees. All of these changes were significant. Bony union was achieved in all patients. There were no significant changes in peak pressure, pressure/time, or force/time pedobarography noted after 12 months. Significant improvement in pain scores from preoperative mean of 21.29 +/- 11.0 to 32.90 +/- 9.57 at 5 years (P < .01) was noted and 90.9% of patients remained satisfied with the operation and would recommend the procedure. There were 2 complications. One patient experienced a traumatic neuroma and another avascular necrosis of the first metatarsal head. The scarf osteotomy is a safe and effective procedure with reproducible and excellent medium-term results
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NewsBot · May 4, 2009

The effect of sesamoid position on outcome following scarf osteotomy for hallux abducto valgus
J.D. Wilson, J. Baines LMS, M.S. Siddique and R. Fleck
Foot and Ankle Surgery Volume 15, Issue 2, June 2009, Pages 65-68

Background
Hallux valgus is a common forefoot condition, with numerous operations described to correct the deformity. Debate remains as to the relative importance of correcting the position of the sesamoid apparatus.

Methods
Forty-six cases were reviewed. Preoperative and post-operative X-rays were used to measure forefoot width, inter-metatarsal angle (IM), hallux valgus (HV) angle and sesamoid position (Reynolds stations). Satisfaction was assessed via questionnaire.

Results
Significant improvements were seen in all radiological parameters. 37/43 patients were satisfied with the result. Comparison between the satisfied and non-satisfied group revealed significant differences in the IM angle (p < 0.05) and HV angle (p < 0.05). However, patient satisfaction was not associated with post-op sesamoid position or change in sesamoid position (p > 0.05).

Conclusions
This study showed that scarf osteotomy, can successfully correct hallux valgus, with high levels of satisfaction. Satisfaction is associated with a greater correction of deformity. Improvement in sesamoid position was not associated with patient satisfaction
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drsarbes · May 5, 2009

" However, in this, shifting of the distal fragment is limited and the results show that the Austin method should be preferred in deformities with an IMT angle of about 10 degrees. "

Ridiculous!

Steve

NewsBot · May 8, 2009

Outcome of the scarf osteotomy in adolescent hallux valgus.
George HL, Casaletto J, Unnikrishnan PN, Shivratri D, James LA, Bass A, Bruce CE.
J Child Orthop. 2009 May 7. [Epub ahead of print]

PURPOSE: We have reported the radiological and clinical outcome of scarf osteotomy in the treatment of moderate to severe hallux valgus among adolescent children.

METHOD: Data were collected retrospectively between April 2001 and June 2006. The pre- and post-operative intermetatarsal angle (IMA), hallux valgus angle (HVA) and distal metatarsal articular angle (DMAA) were determined. Patients were followed up for a mean of 37.6 months.

RESULTS: Thirteen patients with 19 operated feet were available at the time of the latest follow-up. There was significant improvement in the mean post-operative IMA, which was maintained to the last follow-up. There was statistically significant improvement in the 6-week post-operative HVA and DMAA. However, this was lost at the final follow-up. The mean American Orthopaedic Foot and Ankle Society score for the whole group was 80 (54-100).

CONCLUSION: This study indicates that scarf osteotomy should be used with caution in symptomatic adolescent hallux valgus, as there is a high recurrence rate.
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NewsBot · Sep 24, 2009

Bosch osteotomy and scarf osteotomy for hallux valgus correction.
Maffulli N, Longo UG, Oliva F, Denaro V, Coppola C.
Orthop Clin North Am. 2009 Oct;40(4):515-24, ix-x.

Minimally invasive distal metatarsal osteotomies are becoming broadly accepted for correction of hallux valgus. We compared the duration of surgery, the length of hospital stay, the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Foot and Ankle Outcome Score (FAOS) in 36 patients who underwent a minimal incision subcapital osteotomy of the first metatarsal with 36 matched patients who had hallux valgus corrected by a scarf technique. The minimum follow-up was 2.1 years (mean, 2.5 years; range, 2.1-3.2 years). Patients having the osteotomy had similar AOFAS and FAOS scores with less operating time and earlier discharge. Less operative time may benefit the patients, and earlier discharge has financial implications for the hospital.
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NewsBot · Oct 3, 2009

Prospective comparative study of the scarf and ludloff osteotomies in the treatment of hallux valgus.
Robinson AH, Bhatia M, Eaton C, Bishop L.
Foot Ankle Int. 2009 Oct;30(10):955-63.

BACKGROUND: This study compares two diaphyseal osteotomies (scarf and Ludloff) which correct moderate to severe metatarsus primus varus. This is a single surgeon, prospective cohort study with clinical and radiological follow~up at 12 months.

MATERIALS AND METHODS: There were 57 patients in each group. Both groups were similar in terms of age, gender and preoperative deformity. Clinical assessment included visual analogue scale questionnaires for subjective assessment and functional activities and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Standardized weight bearing radiographs were analyzed.

RESULTS: There was no statistically significant difference between the two groups at 6 and 12 months in subjective satisfaction, AOFAS score, improvement in functional activities and range of movements. The improvement in pain (at best) and transfer lesions at 12 months was significantly better in the scarf group (p < 0.05). The radiological results at 6 and 12 months including intermetatrsal angle (p < 0.001), hallux valgus angle (p < 0.01), distal metatarsal articular angle and seasmoid position (p < 0.05) were significantly better in the scarf osteotomy group. There were three cases (5%) of delayed union in the Ludloff group. Two of these healed with dorsiflexion malunion. One patient in the Ludloff osteotomy group developed a complex regional pain syndrome. There were two wound complications in the scarf group.

CONCLUSION: Overall the patients who had a scarf osteotomy had a superior outcome at 6 and 12 months.
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NewsBot · Jan 24, 2010

Scarf Osteotomy for Hallux Valgus Deformity
A Prospective Study with 8 Years of Clinical and Radiologic Follow-up
Jeroen J. K. De Vil, Peter Van Seymortier, Willem Bongaerts, Pieter-Jan De Roo, Barbara Boone, and René Verdonk,
Journal of the American Podiatric Medical Association Volume 100 Number 1 35-40 2010

Background: Scarf midshaft metatarsal osteotomy has become increasingly popular as a treatment option for moderate-to-severe hallux valgus deformities because of its great versatility. Numerous studies on Scarf osteotomy have been published. However, no prospective studies were available until 2002. Since then, only short-term follow-up prospective studies have been published. We present the results of a prospective study of 21 patients treated by Scarf osteotomy for hallux valgus with follow-up of 8 years.

Methods: Between August 1, 1999, and October 31, 1999, 23 patients (23 feet) with moderate-to-severe hallux valgus deformity were included. Clinical (American Orthopaedic Foot and Ankle Society score) and radiologic (hallux valgus angle, first intermetatarsal angle, and sesamoid position) evaluations were performed preoperatively and 1 and 8 years postoperatively.

Results: Clinical evaluation showed a significant improvement in the mean forefoot score from 47 to 83 (of a possible 100) at 1 year (P < .001). Radiographic evaluation showed significant improvement in the hallux valgus angle (mean improvement, 19°; P < .001) and in the intermetatarsal angle (mean improvement, 6°; P < .001). These clinical and radiographic results were maintained at the final evaluation 8 years postoperatively.

Conclusions: Scarf osteotomy tends to provide predictable and sustainable correction of moderate-to-severe hallux valgus deformitie
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NewsBot · Feb 17, 2010

Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients
Tim E Kilmartin and Claire O'Kane
Journal of Foot and Ankle Research 2010, 3:2doi:10.1186/1757-1146-3-2

Background
The Cochrane review of hallux valgus surgery has disputed the scientific validity of hallux valgus research. Scoring systems and surrogate measures such as x-ray angles are commonly reported at just one year post operatively but these are of dubious relevance to the patient. In this study we extended the follow up to a minimum of 8 years and sought to address patient specific concerns with hallux valgus surgery. The long term follow up also allowed a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies.

Methods
Between 1996 and 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. All patients were contacted and asked to participate in this study. 50 female participants were available allowing review of 73 procedures. The average follow up was over 9 years and the average age at the time of surgery was 57. The participants were physically examined and interviewed.

Results
Post-operatively, in 86% of the participants there were no footwear restrictions. Stiffness of the first metatarsophalangeal joint was reported in 8% (6 feet); 10% were unhappy with the cosmetic appearance of their feet, 3 feet had hallux varus, and 2 feet had recurrent hallux valgus. There were no foot-related activity restrictions in 92% of the group. Metatarsalgia occurred in 4% (3 feet). 96% were better than before surgery and 88% were completely satisfied with their post-operative result. Hallux varus was the greatest single cause of dissatisfaction. The most common adverse event in the study was internal fixation irritation. Hallux valgus surgery is not without risk and these findings could be useful in the informed consent process.

Conclusions
When combined the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that achieves good long-term correction with a low incidence of recurrence, footwear restriction or metatarsalgia. The nature of the osteotomies allows early return to normal shoes and activity without the need for postoperative immobilisation in a plaster cast.
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NewsBot · Feb 17, 2010

Mid-term results of Scarf osteotomy in hallux valgus.
Fuhrmann RA, Zollinger-Kies H, Kundert HP.
Int Orthop. 2010 Feb 16. [Epub ahead of print]

We performed a retrospective study on 178 Scarf osteotomies with a mean follow-up of 44.9 months (range 15-83 months). Clinical rating was based on the forefoot score of the American Orthopaedic Foot and Ankle Society (AOFAS). Weight bearing X-rays were used to perform angular measurements and assess the first metatarsophalangeal joint (MTP 1). At follow-up the mean AOFAS score had improved significantly (p < 0.001), but only 55% of the feet showed a perfect realignment of the first ray. Patients with a hallux valgus angle exceeding 30 degrees and pre-existing degenerative changes at the MTP 1 joint displayed inferior clinical results (p < 0.05). Nearly 20% of the patients suffered from pain at the MTP 1 joint. This was clearly attributed to an onset or worsening of distinct radiographic signs of arthritis (p < 0.05) resulting in painfully decreased joint motion. Comparing radiographic appearance three months postoperatively and at follow-up, we found that radiographic criteria (hallux valgus, first intermetatarsal angle, hallux valgus interphalangeus, MTP 1 joint congruency, arthritic lesions at MTP 1) worsened with time.
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NewsBot · May 28, 2010

The Scarf Osteotomy: A Salvage Procedure for Recurrent Hallux Valgus in Selected Cases
Peter Bock, Ulrich Lanz, Andreas Kröner, Georg Grabmeier and Alfred Engel
Clinical Orthopaedics and Related Research

Background
The Scarf osteotomy was described as a technique to correct a metatarsus primus varus in primary hallux valgus surgery, but it is unclear whether the technique could correct recurrent hallux valgus when an initial procedure failed to provide any or an adequate lateral displacement of the metatarsal head.
Questions/purposes
We asked whether the Scarf osteotomy could reduce pain, improve the AOFAS score, reduce the deformity, and prevent further recurrence when used as a revision procedure.
Patients and Methods
Of 41 patients (45 feet) we treated for failed initial operations, we retrospectively reviewed 35 (39 feet) who underwent a Scarf osteotomy. We administered a VAS for pain and the AOFAS score preoperatively and postoperatively. Preoperative and postoperative radiographs were taken to assess the hallux valgus angle [HVA] and intermetatarsal angle [IMA]. The minimum followup was 24 months (mean, 42 months; range, 24–89 months).
Results
The mean VAS for pain improved from 5.9 to 0.4 points. The mean AOFAS score improved from 56 to 90 points. The radiographic evaluation showed improvement of the mean HVA from 30° to 8° and improvement of the IMA from 13° to 4°. Complications included one asymptomatic recurrence with a 20°-HVA, one overcorrection with a 3°-varus deformity, and pain attributable to irritation caused by screws in five patients.
Conclusions
As a revision procedure the Scarf osteotomy clinically and radiographically corrected recurrent hallux valgus recurrence in most patients.
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NewsBot · Aug 14, 2010

Outcomes after Scarf Osteotomy for Treatment of Adult Hallux Valgus Deformity.
Adam SP, Choung SC, Gu Y, O'Malley MJ.
Clin Orthop Relat Res. 2010 Aug 13. [Epub ahead of print]

BACKGROUND: Many procedures have been developed to correct hallux valgus deformity using distal soft tissue realignment, metatarsal osteotomy, and periodically, a proximal phalanx osteotomy (Akin). The ideal metatarsal osteotomy allows for varying degrees of correction with reliable improvement in deformity and patient satisfaction.

QUESTIONS/PURPOSES: We evaluated the results after scarf osteotomy with respect to American Orthopaedic Foot and Ankle Society (AOFAS) scores, patient satisfaction, radiographic results, and complications. PATIENTS AND METHODS: We evaluated 29 patients (34 feet) during an 18-month period who underwent a unilateral scarf osteotomy combined with distal soft tissue realignment. Preoperative and postoperative AOFAS scores, patient satisfaction, and radiographic data were used to evaluate the effectiveness of the procedure. Complications were recorded. Minimal followup was 12 months (average, 26.4 months; range, 12-48 months).

RESULTS: The mean AOFAS scores improved from 61.5 to 90.3. At final followup, 94% of patients were satisfied with the surgery. The hallux valgus angle improved from 34.6 degrees to 14.9 degrees and the intermetatarsal angle improved from 15.8 degrees to 7.2 degrees postoperatively. A combined Akin osteotomy was performed in only four cases. Complications included superficial wound infection (one), recurrence (two), and troughing (three).

CONCLUSIONS: Our results suggest the scarf osteotomy produces improved AOFAS scores, high percentage of patient satisfaction, and effective correction of hallux valgus deformities. Using our scarf technique of rotation combined with translation minimizes the need for an Akin osteotomy while still obtaining good correction and avoids associated complications described in the literature
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NewsBot · Oct 22, 2010

Scarf and Weil metatarsal osteotomies of the lateral rays for correction of rheumatoid forefoot deformities: a systematic review.
Roukis TS.
J Foot Ankle Surg. 2010 Jul-Aug;49(4):390-4.

Scarf osteotomy of the first ray combined with Weil distal oblique shortening osteotomies of the lateral rays has recently been proposed for the treatment of global rheumatoid forefoot deformities because of the perceived benefit of sparing the metatarsal-phalangeal joints. Furthermore, it has been proposed that undergoing this form of global forefoot reconstruction is reliable based on specific preoperative and intraoperative techniques used to realign the individual rays. Finally, it has been proposed that performing global forefoot reconstruction in the rheumatoid patient population can be safely performed and does not prevent the ability to perform revision surgery. The author undertook a systematic review of electronic databases and other relevant sources to identify material relating to Scarf osteotomy of the first ray combined with Weil distal oblique shortening osteotomies of the lateral rays for the treatment of global rheumatoid forefoot deformities. Information from peer-reviewed journals, as well as from non-peer-reviewed publications, abstracts and posters, textbooks, and unpublished works, was also considered. In an effort to procure the highest quality studies available, studies were eligible for inclusion only if they involved patients undergoing Scarf osteotomy of the first ray combined with Weil distal oblique shortening osteotomies of the lateral rays, evaluated patients at mean follow-up of 12-months or longer duration, commented on the reliability of metatarsal realignment, and included details of complications, as well as the incidence and severity of wound-healing complications. Two studies were identified that met the inclusion criteria involving only 8 patients (8 feet) with 1 patient undergoing surgical revision in the form of arthrodesis secondary to development of a septic first metatarsal-phalangeal joint. Partial incision dehiscence developed in 2 patients, 1 healed with local wound care and the other led to the septic first metatarsal-phalangeal joint mentioned previously. Finally, stress fracture of the third metatarsal and fourth metatarsals developed that healed without problems in one other patient. Rather than providing strong evidence for or against the use of Scarf osteotomy of the first ray combined with Weil distal oblique shortening osteotomies of the lateral rays for the treatment of global rheumatoid forefoot deformities, the results of this systematic review make clear the need for methodologically sound prospective cohort studies and randomized controlled trials that focus on the use of this form of surgical intervention.
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blinda · Nov 25, 2010

guccibagstar25 said: ↑

Maybe feet contact lots of bacteria.
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http://www.youtube.com/watch?v=anwy2MPT5RE

NewsBot · Dec 23, 2010

Inverted Z-scarf Osteotomy for Hallux Valgus Deformity Correction: Intermediate-term Results in 55 Patients.
Miller JM, Ferdowsian VN, Collman DR.
J Foot Ankle Surg. 2011 Jan-Feb;50(1):55-61.

The Z-scarf osteotomy is used for hallux valgus deformity correction by foot and ankle surgeons worldwide. Inverting the Z-scarf osteotomy configuration strengthens the construct in both sawbone and cadaver models, but clinical results of this configuration have not been reported in the literature. This retrospective study evaluates the subjective and intermediate-term postoperative radiographic results of 73 inverted Z-scarf osteotomy procedures for hallux valgus correction in 55 patients from January 1994 to December 2003. The modified University of Maryland 100-Point Painful Foot Center Scoring System demonstrated 52 patients (95%) with good to excellent results at a mean follow-up of 5 years (range 2-11 years). Radiograph measurements revealed the following: first-second intermetatarsal angle mean, 6.1° (range 2-14°), average reduction 4.6°; hallux abductus angle mean, 11.0° (range -8-30°), average reduction 10.1°; tibial sesamoid position mean, 2.3; first metatarsal protrusion distance mean, -2.1 mm. Two patients (2 of 73 feet) developed major complications: one progressed to clinically acceptable hallux varus; another sustained compromise of one fixation screw with minor displacement at the distal osteotomy that healed in satisfactory position after non-weight-bearing immobilization. There were no cases of osteonecrosis, delayed union, or nonunion. The inverted Z-scarf osteotomy, with advantages in both mechanical strength and technique of execution over the traditional configuration, demonstrates high patient satisfaction, restoration of normal radiographic parameters, and a low complication rate in this study.
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NewsBot · Feb 19, 2011

Evaluation of scarf osteotomy for management of hallux valgus deformity.
Aly TA, Mousa W, Elsallakh S.
Orthopedics. 2011 Jan 1;34(2). doi: 10.3928/01477447-20101221-08.

Hallux valgus is a complex progressive deformity affecting the forefoot. The main pathologic anatomy concerns the first metatarsophalangeal joint, including a varus or medial deviation of the first metatarsal and pronation deformity in the longitudinal axis. The goal of this study was to evaluate a series of consecutive patients over a 2-year period after a scarf osteotomy of the first metatarsal.A scarf osteotomy was performed on 31 consecutive patients with moderate to severe hallux valgus deformity (intermetatarsal angle, 13-22°; hallux valgus angle, 20-44°). Twenty-nine women and 2 men had an average age of 57 years (range, 21-71 years) at the time of surgery. Preoperative and postoperative evaluations included standing anteroposterior and lateral radiographs, American Orthopaedic Foot and Ankle Score (AOFAS) score, physical examination, and foot pressure analysis by weight-bearing ink prints. Patients were evaluated radiographically and clinically in the initial postoperative period (≤1 month), intermediate postoperative period (2-6 months), and final follow-up (12-36 months). Twenty-eight feet were available for analysis. Five of the 28 feet had concurrent surgeries on the lesser toes for hammer-toe correction or preoperative metatarsalgia. Paired Student t test on the 28 feet showed a statistically significant improvement (P<.0001) between pre- and postoperative intermetatarsal angle, hallux valgus angle, and AOFAS score. One foot had recurrence of the hallux valgus deformity. Paired analysis of variance of the 27 feet without recurrence showed a statistically significant improvement in the pre- and postoperative parameters (P<.0001). From this subset, the multiple-comparison Student-Newman-Keuis post hoc test showed a statistically significant (P<.0001) preservation of the correction in the intermediate follow-up period to final follow-up at an average 28 months.
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NewsBot · Jul 22, 2011

Interpretation of the scarf osteotomy by 10 surgeons
Mark B. Davies, Chris M. Blundell, Christopher P. Marquis and Avril D. McCarthy
Foot and Ankle Surgery Volume 17, Issue 3, September 2011, Pages 108-112

Background
The study compared three-dimensional (3D) changes in geometry of the first metatarsal following scarf osteotomy performed on standardised Sawbone® models by consultant foot and ankle surgeons. The study considered the inter-surgeon variances in interpretation and performance of the scarf osteotomy with respect to intra-surgeon variances.

Methods
The analysis used an accurate digitising system to measure and record points on the Sawbone® models in 3D space. Computer software performed vector analysis to calculate 3D rotations and translations of the first metatarsal head as well as the inter-metatarsal angle. Bone cut lengths and displacements were measured using a digital Vernier caliper. One surgeon performed the osteotomy 10 times to form an intra-surgeon control dataset, while 10 different surgeons each did one scarf osteotomy to form an inter-surgeon test dataset.

Results
Both surgical groups produced reductions in the 3D inter-metatarsal angle with non-significant differences between the groups (p > 0.05). In contrast, the test group demonstrated highly significant (p = 0.000) greater variance compared with the control dataset for all of the variables associated with surgical technique. In addition, there were highly significant (p = 0.02 and 0.002) greater variances in the interpretation of the degree to which the metatarsal head should be translated medially (X) and inferiorly (Z). There was also a significant (p = 0.001) increase in variances in the rotations about the dorsi/plantar-flexion (X) axis.
The only significant differences (all p = 0.000) attributable solely to differences in mean values were in proximal–distal (Y) translation, pronation (Y) rotation and medial (Z) rotation. The test group applied greater medial and plantar-flexion rotation of the metatarsal head than the control surgeon and significantly less (p = 0.000) shortening of the first metatarsal than the control surgeon.

Conclusions
The results of this geometric study demonstrate the versatility of the scarf osteotomy. As a result of the multi-planar nature of the osteotomy, there is a potential risk of producing unintended rotational mal-unions in all three planes. These rotational mal-unions may account for some of the poorer outcomes documented within the literature.
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Drsilver · Aug 18, 2011

Although this thread is old, I thought I'd add my comments.

I'm a big fan of the scarf. I feel it allows me to get significant IM reduction greater than a distal osteotomy and allow a much easier recovery than a base wedge, opening or closing. I do the rotational scarf rather than the transpositional as I too experienced troughing in the past. I have had success with both cannulated and noncsnnulated screws. the medial incision allows for excellent visualization of the screw position. Often I combine scarfs with Akins.

I have had great success with scarf procedures for large bunions that would not have faired well with distal osteotomies.

Lawrence Silverberg, DPM
New York, NY
Blog: www.bestpodiatristnyc.com

NewsBot · Sep 7, 2012

Scarf osteotomy versus metatarsophalangeal arthrodesis in forefoot first ray disorders: Comparison of functional outcomes.
Desmarchelier R, Besse JL, Fessy MH; The French Association of Foot Surgery (AFCP).
Orthop Traumatol Surg Res. 2012 Aug 27.

INTRODUCTION:
Scarf osteotomies of the first metatarsal and metatarsophalangeal arthrodesis are the two most frequent surgical forefoot reconstructive procedures.

HYPOTHESIS:
We compared functional results of isolated arthrodesis of the first metatarsophalangeal joint with an isolated Scarf osteotomy of the first metatarsal.

MATERIALS AND METHODS:
This was a retrospective, observational, continuous study of patients operated between 1993 and 2008. After patients who had undergone a procedure on the lateral rays, extremely elderly patients, lost to follow-up patients and those with incomplete questionnaires had been excluded, there remained two comparable groups of 25 patients. Mean age was 60 in the arthrodesis group [41-70] and 59.8 in the Scarf group [47-71]. The Scarf group included 25 hallux valgus (100%) compared to 16 hallux valgus (64%) and nine hallux rigidus (36%) in the arthrodesis group. Complications were recorded. Evaluation of functional results was based on the most recent functional or quality of life scores (AOFAS, FFI, FAAM, SF 36) and a questionnaire on physical and athletic ability.

RESULTS:
There was no significant difference in the rate of complications between the two groups. There was no difference in pain according to the AOFAS score with 35.6/40 (±6.5) in the Scarf group and 34.5 (±5.9) in the arthrodesis group. Global satisfaction was also similar between the Scarf and arthrodesis groups: 91.4% and 90% of very satisfied or satisfied patients, respectively. The FFI score was higher in the Scarf group than in the arthrodesis group: 8.6 (±20.1) and 19.8 (±17.7) respectively. Functional results were better in the Scarf group than in the arthrodesis group with a FAAM Daily Activity score of 80.2 (±12.1) compared to 68 (±7.2), a FAAM Sports Activity score of 29.7 (±6.7) compared to 25.2 (±7.6) and a FAAM Global Function score of 94% (±10.8) compared to 87% (±15.7), respectively. The Global SF36 score was higher in the Scarf group than in the arthrodesis group: 70.9% (±14.1) and 62.3% (±20.6) respectively, which was due to a higher Mental Health score in the Scarf group: 68.7% (±14.2) and 60.4% (±19.3) respectively. In the area of sports activities the Scarf group practiced more hiking than the arthrodesis group (74% versus 42% respectively). There was no difference for other activities.

DISCUSSION AND CONCLUSION:
This study provides detailed information on the level of physical and sports activities that are practiced following these procedures, so that the patient can be better informed.
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NewsBot · Oct 2, 2012

SCARF OSTEOTOMY IN THE MANAGEMENT OF SYMPTOMATIC ADOLESCENT HALLUX VALGUS
N.G. Farrar, N. Duncan, N. Ahmed, G. Geary, and R.A. Rajan
J Bone Joint Surg Br 2012 94-B:(SUPP XLIII) 10.

This study was designed to assess the utility of the scarf osteotomy in the management of symptomatic adolescent hallux valgus.

Methods This is a consecutive case series of 30 patients (40 feet) with a mean follow up of 38.2 months (range 6–60 months). The mean age at the time of surgery was 14.2 years (range 10–17 years). American Orthopaedic Foot and Ankle Society scores (AOFAS) were collected at final follow up, along with a rating of the overall satisfaction. Any complications were recorded. Pre and postsurgical radiographic angles were measured (HVA, IMA and DMAA) and analysed using the students ‘t’ test. A second surgeon additionally recorded the angles to measure the inter-rater reliability using the Pearson product moment correlation.

Results The mean AOFAS score at final follow up was 91.2 (range 54–100). 87% of patients were either satisfied or very satisfied with their final outcome. 1 patient has been listed for revision surgery after symptomatic recurrence at 3 years follow up. Pre-op HVA, IMA and DMAA were 35.1, 16.1 and 16.3 respectively. Post-op values were 16.3, 8.8 and 9.0 (p < 0.001 for each). Pearson's r coefficient values demonstrated good inter-rater reliability of measurement.

Conclusion We have presented the results of the largest case series of scarf osteotomies for adolescent hallux valgus reported in the literature at this point, as far as we are aware. AOFAS scores at final follow up are comparable to the smaller studies previously reported and provide evidence that good outcomes and high levels of patient satisfaction can be achieved. Early follow up demonstrates a low level of symptomatic recurrence, but longer term data is still required.
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NewsBot · Oct 4, 2012

ARE ROUTINE X-RAYS 6 WEEKS POST SCARF OSTEOTOMY FOR HALLUX VALGUS NECESSARY
M. Dafydd, N. Green and S. Kadambande
J Bone Joint Surg Br 2012 vol. 94-B no. SUPP XLIII 9

Introduction The aim of this study was to assess whether routine X-Rays at six weeks altered the subsequent management of patients who underwent a Scarf osteotomy.

Materials and Methods Between 1997 and 2010, 218 consecutive primary scarf osteotomies of the first metatarsal were performed by two foot and ankle surgeons in a single unit. 71 were combined with an Akin closing wedge osteotomy of the proximal phalanx of the great toe and soft tissue release. Additional osteotomies were performed on the lesser toes in 30 cases. Intraoperative X-Rays were taken. We retrospectively looked at clinic letters for all patients who attended six weeks post operatively and recorded the outcomes following X-Rays.

Results 209 patients were assessed six weeks post operatively with radiographs of the foot. 9 patients were lost to follow up. Four patients (1.9%) were identified as having complications at the osteotomy: recurrence of deformity seen in two patients, delayed union with failure of fixation, and painless hypertrophic nonunion.

Discussion Only a very small proportion of patients developed complications at the osteotomy site following a Scarf osteotomy for hallux valgus. Both cases of recurrence were diagnosed clinically. Failure of fixation was due to poor patient compliance. No revision procedures were planned for any patients.

Conclusion The senior author no longer requests postoperative X-Rays routinely. We believe that the majority of patients may be safely and successfully assessed clinically following Scarf osteotomy without the need for routine X-Rays.
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NewsBot · Nov 12, 2012

Scarf osteotomy without internal fixation to correct hallux valgus
T. Leemrijse, M. Maestro, K. Tribak, V. Gombault, B. Devos Bevernage, P.-A. Deleu
Orthopaedics & Traumatology: Surgery & Research; 8 November 2012

Scarf osteotomy of the first metatarsal bone to correct hallux valgus deformity has benefited from a number of improvements over the past two decades, most notably regarding the internal fixation method. Internal fixation was deemed mandatory by the authors of early case-series studies. Maestro suggested eliminating the proximal screw by locking the two fragments distally: a notch was created via a medial extension of the cephalic part of the osteotomy, the plantar fragment was displaced laterally, and the distal end of the proximal fragment was then fit into the notch (secondary cut and interlocking joint technique). To further develop this concept and to increase the potential range of translation, we developed an original technique involving distal locking without shortening and proximal stabilisation by impaction of a cortical-cancellous bone graft taken from the medial overhanging edge of the proximal fragment. This original technical variant has not been reported previously.
Keywords
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NewsBot · Dec 31, 2012

Mastering The Technical Approach To The Scarf Bunionectomy

NewsBot · Feb 5, 2013

Short Scarf Osteotomy for Moderate Hallux Valgus.
Kwon SY, Gil HJ, Chung JW.
J Korean Foot Ankle Soc. 2012 Dec;16(4):235-240.

PURPOSE: The aim of this study was to evaluate the radiographic and clinical results of short scarf osteotomy that has minimized longitudinal cut for moderate hallux valgus.

MATERIALS AND METHODS: Total 12 patients (12 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 41.5 years. The mean followup time was 21.2 months. We modified original scarf osteotomy by shortening the longitudinal cut to 15~20 mm in length. Additionally, Akin osteotomy of the first proximal phalanx was done in 7 feet and Weil osteotomy of the second metatarsal was done in 4 feet. First-second intermetatarsal and hallux valgus angles were analyzed radiographically before and after the operation. And the clinical result was assessed by AOFAS (American Orthopaedic Foot and Ankle Society) hallux score.

RESULTS: First-second intermetatarsal and hallux valgus angles were reduced from the mean preoperative values of 14.6degrees and 32.8degrees to 6.5degrees and 11.2degrees, respectively. The mean AOFAS hallux score was increased from 52.4 points preoperatively to 88.2 points at followup. Three complications were found: metatarsal fracture during the operation, painful scar around second metatarsal head after Weil osteotomy and postoperative neuralgia. There was no transfer metatarsalgia or recurrence of hallux valgus during followup.

CONCLUSION: Short scarf osteotomy would be an effective surgical procedure for moderate hallux valgus with the benefits of minimized soft tissue dissection and stable fixation.
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NewsBot · Mar 19, 2013

Effect of Scarf Osteotomy on the First Cuneometatarsal Joint
Jean M. Brilhault, MD, Tours, France
Vincent Noël, MD, Tours, France
AAOS Annual Conference 2013

INTRODUCTION: Scarf osteotomy has become a validated treatment for mild to moderate hallux valgus. However, since there is no ligament binding the first to the second metatarsal, the first cuneometatarsal joint may be overloaded by the bowing effect induced by the osteotomy. The goal of this study was to evaluate the impact of the scarf osteotomy on the medial cuneometatarsal joint after hallux valgus surgery.

METHODS: A retrospective study was performed on female patients over 18 years of age with symptomatic mild-to-moderate primitive, isolated hallux valgus deformity without instability of the first cuneometatarsal joint treated with a scarf osteotomy and a 12 months minimum follow up. Main outcome measures were radiographic modification of the first cuneometatarsal joint as well as geometrical parameters.

RESULTS: Forty-nine cases (38 patients) followed in a standardized prospective fashion were included in the study. Mean follow up was 17 months. Every osteotomy healed. Mean metatarso-phalangeal angle evolved from 27.9°+/-7.0. to 4.5°+/-7.9. Mean scarf induced angle on the first metatarsal was 12.4°+/-2.7. Significant increases were observed on inter-metatarsal gap at cuneometatarsal joint level going from 3.3mm+/-1.2 to 4.2+/-1.2. Correlations were observed between these two parameters and preoperative metatarso-phalangeal and inter-metatarsal angles. Thirty-six feet had degenerative change of the first cuneometatarsal joint according the to the four points score by Graves et al. None of the feet were symptomatic at follow up.

DISCUSSION AND CONCLUSION: This study suggests that scarf induced geometrical modifications of the first metatarsal widen the inter-metatarsal distance between the first and second metatarsal at cuneometatarsal level. It is associated with moderate degenerative changes on the first cuneometatarsal joint. It is our understanding that the distal shift of the first metatarsal performed by the osteotomy pushes back the metatarsal head on the sesamoïdes bones but also pulls medially on the first cuneometatarsal joint overloading it. These modifications observed at a short-term follow up bring concerns for the long-term degenerative change of the first cuneometatarsal joint thus potentially narrowing indications of scarf and other metatarsal shaft osteotomies of hallux valgus surgery.
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NewsBot · May 4, 2013

Prospective study of the treatment of adult primary hallux valgus with scarf osteotomy and soft tissue realignment.
Choi JH, Zide JR, Coleman SC, Brodsky JW.
Foot Ankle Int. 2013 May;34(5):684-90.

BACKGROUND:
The scarf osteotomy has been a widely practiced bunion operation, but relatively limited prospective data on its outcomes have been reported. The purpose of this investigation was to prospectively evaluate the clinical and radiographic results of treatment of adult primary hallux valgus using the scarf osteotomy of the first metatarsal with soft tissue realignment.

METHODS:
Hallux valgus corrections were performed on 51 patients (53 feet), who were followed for at least 1 year with an average follow-up of 24 months. Mean age at the time of surgery was 59 years, and subjects included 3 male and 48 female patients. Prospective clinical data collected included the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-interphalangeal scale score, the SF-36 scores, and the visual analogue scale (VAS) for pain. Data were collected preoperatively and postoperatively. Prospective radiologic data were also collected including hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), and medial sesamoid position (MSP). Clinical data were collected on complications and reoperations.

RESULTS:
Mean AOFAS hallux-interphalangeal score increased from 52 preoperatively to 88 postoperatively. Mean preoperative and last follow-up SF-36 physical component summary increased from 46 preoperatively to 52 postoperatively, whereas mean VAS pain scores decreased from 5.8 preoperatively to 1.1 postoperatively. All the changes in clinical outcomes were statistically significant, except the Mental Component Summary of the SF-36. Mean preoperative HVA decreased from 29 degrees preoperatively to 10.7 degrees in the initial postoperative period and was maintained at last follow-up at 10.6 degrees. The mean preoperative IMA decreased from 13.6 degrees preoperatively to 5.6 degrees in the initial postoperative period and regressed mildly at last follow-up to 7.8 degrees. The mean preoperative MSP grade of 2.3 decreased to 0.5 in the initial postoperative period and regressed mildly to 0.9 at last follow-up. All radiographic changes were statistically significant. The overall complication rate was 15% (8/53), attributable to 4 feet with symptomatic hardware, 2 feet with hallux varus, and 2 feet with progression of first MTP arthritis. Reoperations were performed in 4 feet (8%) for removal of symptomatic hardware.

CONCLUSION:
Scarf osteotomy was a reliable technique for correction of moderate to severe hallux valgus and had low rates of complication or recurrence.
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NewsBot · May 9, 2013

Short-term Clinical and Radiologic Results of the Scarf Osteotomy: What Factors Contribute to Recurrence?
Alper Deveci, MD, Ahmet Firat, MD, Serdar Yilmaz, MD, Ozdamar Fuad Oken, MD, Ahmet Ozgur Yildirim, MD, Ahmet Ucaner, MD, Murat Bozkurt, MD
Journal of Foot and Ankle Surgery; Article in Press

The present retrospective investigation aimed to determine the factors associated with recurrence of hallux valgus deformity after scarf osteotomy in 50 feet in 43 consecutive patients. We hypothesized that hallux abductovalgus after scarf osteotomy recurs because of the presence of preoperative joint incongruity. The clinical and radiographic findings, including the weightbearing radiographic hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, first metatarsophalangeal joint congruence, American Orthopaedic Foot and Ankle Society scores, and pain measured on a visual analog scale, and logistic regression analysis were used to analyze the association of the independent variables with the recurrence of deformity. The mean age of the patients was 47.7 (range 21 to 65) years, and the mean follow-up duration was 26.2 (range 18 to 36) months. The mean American Orthopaedic Foot and Ankle Society scores improved from 50.7 ± 4.9 to 88.7 ± 7.9, and the visual analog scale pain scores improved from 7.5 ± 1.1 to 2.4 ± 1.0 (p < .05). The changes in the radiographic measurements were also statistically significant. Of the 50 feet, 5 (10%) developed recurrent hallux abductovalgus, each of which occurred in feet that had displayed a first metatarsophalangeal joint incongruity on preoperative radiographs. The incongruity was observed to be a statistically significant risk factor for recurrence according to the regression models. From our experience with the patients analyzed in the present report, we believe that first metatarsophalangeal joint congruity should be given particular attention when surgical correction of hallux abductovalgus is undertaken.
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NewsBot · Jun 6, 2013

Scarf osteotomy in the management of symptomatic adolescent hallux valgus.
Farrar NG, Duncan N, Ahmed N, Rajan RA.
J Child Orthop. 2012 Jun;6(2):153-7.

PURPOSE:
This study was designed to assess the utility of the scarf osteotomy in the management of symptomatic adolescent hallux valgus.

MATERIALS AND METHODS:
This is a case series of 29 patients (39 feet) with a mean follow up of 38.6 months (range 6-60 months). The mean age at the time of surgery was 14.1 years (range 10-17 years). American Orthopaedic Foot and Ankle Society (AOFAS) scores were collected at final follow up, along with a rating of the overall satisfaction. Any complications were recorded. Pre- and post-surgical radiographic angles were measured and analysed using the Student's t-test. The angles measured were the hallux valgus angle (HVA), the inter-metatarsal angle (IMA) and the distal metatarsal articular angle (DMAA). A second surgeon independently reviewed the angles in order to assess the inter-rater reliability using the Pearson product moment correlation.

RESULTS:
The mean AOFAS score at final follow up was 94.2 (range 54-100). Of all patients, 93 % were either satisfied or very satisfied with their final outcome. One patient has been listed for revision surgery after symptomatic recurrence at 3 years follow up. The pre-operative HVA, IMA and DMAA were 34.8°, 15.9° and 16.0°, respectively. The post-operative values were 16.3°, 8.8° and 9.2°, respectively (p < 0.001 for each). Pearson's r coefficient values demonstrated good inter-rater reliability of measurement.

CONCLUSION:
We have presented the results of the largest case series of scarf osteotomies for adolescent hallux valgus reported in the literature up to now, as far as we are aware. AOFAS scores at final follow up are comparable to the smaller studies previously reported and provide evidence that good outcomes and high levels of patient satisfaction can be achieved. Early follow up demonstrates a low level of symptomatic recurrence, but longer term data are still required.
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NewsBot · Sep 1, 2013

Lengthening Scarf Osteotomy for Recurrent Hallux Valgus
Barry Rose, Nicholas Bowman, Huw Edwards, Samuel S. Rajaratnam, Andrew R. Armitage, Andrew D. Skyrme
Foot and Ankle Surgery; Available online 1 September 2013

Background
We describe using the scarf osteotomy to correct a recurrent hallux valgus deformity and lengthen the shortened first metatarsal in symptomatic iatrogenic first brachymetatarsia.

Methods
36 lengthening scarf osteotomies were undertaken in 31 patients. Clinical and radiographic measures were taken pre and postoperatively.

Results
Mean age at presentation was 53.4 years, and mean followup 3.9 years. The mean lengthening achieved was 4.9 mm. All osteotomies united with no complications. The mean IMA reduction was 4.0° (p < 0.001) and HVA 13.0° (p < 0.001). The mean AOFAS score increase was 33.8 (p < 0.001). There was a positive trend but no correlation (r = 0.28) between amount of metatarsal lengthening and AOFAS score change.

Conclusions
We describe the largest lengthening scarf osteotomy series for recurrent hallux valgus with iatrogenic first brachymetatarsia. The results suggest the procedure is successful, with a low complication rate. We anticipate that restoring first metatarsal length and alignment may reduce biomechanical transfer metatarsalgia over time.
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Mitchel vs Scarf osteotomy

Rotation Scarf & Akin Osteotomy (RSA) : Is It Safe?

Lapidus or scarf surgery for bunion?

Saggital scarf procedure

8 weeks after Scarf Akin bunion surgery

scarf bunionectomy and still nwb wondering who else had this and when do you get walking boot?

'MoAkin' biplanar proximal phalanx closing wedge osteotomy

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