Scarf osteotomy for the treatment of hallux valgus deformity: a review of 26 cases

The aim of this study was to evaluate Scarf osteotomy, associated or not with phalangeal osteotomy, for the treatment of hallux valgus, and to determine its limits. We performed a retrospective review of 24 patients ( 26 feet) who had been treated by Scarf osteotomy for hallux valgus between July 2000 and June 2005 in the orthopedic traumatology department of University Hospital Centre (CHU) in Casablanca. The results were carefully evaluated according to Groulier scores. The mean follow-up time was 2 years and 6 months. The average age at surgery was 37.5 and the majority of patients were female; 79.2% of the patients were satisfied or very satisfied. According to the Groulier scores, 65.4% of the outcomes were good or very good. There was a correlation between the treatment satisfaction index and clinical symptoms (metatarsalgia and stiff hallux). There was a statistically significant decrease in hallux valgus (36.3 to 16.3 degrees), metatarsus varus (15.8 to 7.3 degrees) and distal metatarsus articular angle (28.5 to 14.8 degrees). The cut-off limits for deformations difficult to correct satisfactorily were MP > 36 degrees, MV angle > 16 degrees and AADM > 14 degrees. Performing a phalangeal osteotomy in addition can improve the radiological results, but it is very difficult to obtain satisfactory correction if the initial deformations are severe, even if associated with Scarf osteotomy.