Correction of hallux valgus by scarf osteotomy - a clinical and radiographical review of 175 cases

The paper elaborates on scarf osteotomy in the treatment of hallux valgus deformity. The study evaluates 175 isolated scarf osteotomies of the first metatarsal (with/without the Akin proce-dure) performed by one surgeon. Radiological (intermetatarsal angle-IMA, hallux valgus angle-HVA, distal-metatarsal articular angle-DMAA, proximal-to-distal phalangeal-articular angle-PDPAA, trans-lation of diaphysis and sesamoid position) and clinical (Foot and Ankle Disability Index -FADI and the American Orthopedic Foot and Ankle Score -AOFAS) evaluation was done before and after treat-ment. The follow-up was from 1 to 10 years. HVA decreased 24 degrees, from 32 degrees +/- 8,8(16 degrees-60 degrees) to 8 degrees +/- 7,4(-27 degrees-32 degrees), IMA decreased 11 degrees, from 15 degrees +/- 3,7(16 degrees-31 degrees) to 4 degrees +/- 2,4(0 degrees-13 degrees), DMAA for 12 degrees-from 17 degrees to 5 degrees, PDPAA for 5 degrees-from 5 degrees to 0 degrees and sesamoid position from 5(2-7) to 1(1-7). The first metatarsal translation was 58%+/- 14,5(17%-94%). FADI enlarged from 65 +/- 18.2(26-99) to 95 +/- 9,7(45-100) and AOFAS from 76 +/- 9,to 6(47-98) 96 +/- 6,9(72-100). All diferences were significant (p<0,05). Recurrence was 4,6%, iatro-genic hallux varus 6,3%, symptomatic screw 9%, transfer metatarsalgia 2,3%, troughing 2,9% superficial wound infection 1,1%, and postoperative hypesthesia 1,1%. Scarf osteotomy is a reliable and safe proce-dure for the correction of moderate to severe hallux valgus deformities. A relatively long learning curve is a burden with solvable complications.