The SCARF osteotomy for treatment of hallux valgus deformity

Abstract

Objective: The use of Scarf osteotomy for treatment of hallux valgus deformity has gain popularity in Europe and United State in the last years, because it is based on principles of great stability and capacity of correction. The aim of this work was to show the clinical and radiographic results of the prospective observation of 51 patients (69 feet) treated with this technique. Methods: Based on the concepts used in roofs and watercrafts carpentry during centuries, the Scarf surgical technique is done with a long Z osteotomy of the first metatarsal for its capacity of absorption, load distribution and great intrinsic stability. The cuts are done with blades for delicate bones and the fragments are dislocated in a way to correct the first ray functional and mechanical axes. Short wedges can be removed from the osteotomy extremities in order to correct the first metatarsal distal articular angle (DMAA). Usually, two screws are used for the stabilization and fixation of the osteotomy fragments. During the period from 2000 to 2004, 51 patients (69 feet) had surgery with this technique, with ages varying from 18 to 74 (mean 46 years); three patients (6%) were males and 48 (94%) females. According to the deformity intensities, six feet (8,7%) were classified as mild, 57 feet (82,6%) were considered moderated and six (8,7%) as severe. Results: At the average, the angular parameters used for the results evaluation (hallux valgus angle – HVA; 1-2 intermetatarsal angle – IMA; distal first metatarsal articular angle – DMAA) were normalized with the surgical technique used (t Student test, pConclusions: The Scarf osteotomy is able to correct hallux valgus complex deformities. However, the capacity of correction does not match with the expectative, complexity and risks of the procedure. As it is a sophisticate technique, with long learning curve and potential for generating severe problems and of difficult solution, we suggest that the indication stays restricted to moderate deformities in young patients.