Scarf Osteotomy

FV Hospital’s Orthopaedics Department has successfully performed scarf osteotomy to correct many cases of hallux valgus deformities. This procedure not only helps to improve the motion functions of the feet but also improves their appearance, and facilitates the patient’s daily activities.

A scarf osteotomy is conducted to correct moderate hallux valgus deformities. The scarf osteotomy is extremely versatile as it allows for several benefits, including lateral shifting and inward rotation of the head-shaft fragment while maintaining joint congruity.

Over 130 metatarsal osteotomies have been described in the world literature for the surgical management of hallux valgus. In clinical practice most of the surgeons limit these to a few procedures which invariably include soft tissue release, medial exostostomy combined with either proximal or distal osteotomy of the first metatarsal.

Any surgical procedure should result in a congruous first metatarsophalangeal joint, pain free motion, improved cosmetic appearance and the ability to wear desirable footwear. The first metatarsal scarf osteotomy has significantly improved the correction in hallux valgus and has recently gained popularity among European surgeons.

The osteotomy in itself involves a Z-shaped cut in the first metatarsal separating the head of the plantar half of the shaft from the rest of the bone. This allows the head-shaft complex to be translated and rotated in order to achieve correction of the deformity while maintaining articular congruity. The bone is then fixed in this position with two small screws. The excess bone on the inside of the foot (medial side) is then removed.
Other advantages of the procedure include:

• Medial shifting of the head-shaft fragment (in cases of hallux valgus)
• Elongation in cases of a short first metatarsal
• Shortening in cases of a long first metatarsal or severe deformity and axial rotation (supination) in cases of first metatarsal pronation.

All parameters were significantly improved by the surgery, and all patients got the desired cosmetic result. All patients were pain free during the recovery period. Follow up appointments will be scheduled in the first 6 months.

Scarf osteotomy is a powerful and versatile procedure to correct hallux valgus deformity. This allows the patient to move shortly post operation, as the osteotomy is inherently stable, and return to work at an earlier date as compared to other procedures.