The scarf osteotomy for the correction of hallux valgus

Introduction: Aim of this study is to analyze complications as well as clinical and radiological results of the scarf osteotomy for the correction of hallux valgus. Patients and Methods: Between 1994 and 1998 we performed a scarf osteotomy for the correction of hallux valgus in 45 cases. Indication was a symptomatic hallux valgus with an increased first intermetatarsal angle (IMA). Fixation of the osteotomy was performed with two 2,3 mm mini screws made of titaneum. Mobilisation was allowed with full weight bearing with a fore foot relief orthesis. Clinical results were valuated with the fore foot scoring system (ffss). The determination of the IMA and hallux valgus angles (HVA) was performed with weight bearing d.p. radiographs. Results: All osteotomies healed within the first 6 postoperative weeks. Removal of the screws was not necessary in any case. The preoperative ffss was 16.2 points. At the last follow up (16 month after surgery) the average value of the ffss was 59.1 points. Three patients reached a value below 35 points, two of them suffered from a rheumatic disease. Twenty patients assessed the cosmetic result as excellent, 16 as good, 4 as satisfactory and one as poor. The average IMA could be reduced significantly from 20,2 to 10,3 degrees. The HVA could be lowered from 37,5 to 20,9 degrees. In patients with an IMA of more than 20 degrees the HVA could be reduced to 23,1 degrees in contrast to 18,3 in patients with an IMA of less than 20 degrees. Discussion: The scarf osteotomiy is a surgical procedure for the correction of hallux valgus due to increased IMA which is appropriate in patients younger than 50 years and older than 50 years. In cases of IMA more than 20 degrees correction of IMA and HVA was unsatisfactory.