Scarf osteotomy in the management of symptomatic adolescent hallux valgus

Purpose This study was designed to assess the utility of the scarf osteotomy in the management of symptomatic adolescent hallux valgus. Materials and methods This is a case series of 29 patients (39 feet) with a mean follow up of 38.6 months (range 6-60 months). The mean age at the time of surgery was 14.1 years (range 10-17 years). American Orthopaedic Foot and Ankle Society (AOFAS) scores were collected at final follow up, along with a rating of the overall satisfaction. Any complications were recorded. Pre- and post-surgical radiographic angles were measured and analysed using the Student's t-test. The angles measured were the hallux valgus angle (HVA), the inter-metatarsal angle (IMA) and the distal metatarsal articular angle (DMAA). A second surgeon independently reviewed the angles in order to assess the inter-rater reliability using the Pearson product moment correlation. Results The mean AOFAS score at final follow up was 94.2 (range 54-100). Of all patients, 93 % were either satisfied or very satisfied with their final outcome. One patient has been listed for revision surgery after symptomatic recurrence at 3 years follow up. The pre-operative HVA, IMA and DMAA were 34.8 degrees, 15.9 degrees and 16.0 degrees, respectively. The post-operative values were 16.3 degrees, 8.8 degrees and 9.2 degrees, respectively (p < 0.001 for each). Pearson's r coefficient values demonstrated good inter-rater reliability of measurement. Conclusion We have presented the results of the largest case series of scarf osteotomies for adolescent hallux valgus reported in the literature up to now, as far as we are aware. AOFAS scores at final follow up are comparable to the smaller studies previously reported and provide evidence that good outcomes and high levels of patient satisfaction can be achieved. Early follow up demonstrates a low level of symptomatic recurrence, but longer term data are still required.