Mid-term results of Scarf osteotomy in hallux valgus

Abstract

We performed a retrospective study on 178 Scarf osteotomies with a mean follow-up of 44.9 months (range 15-83 months). Clinical rating was based on the forefoot score of the American Orthopaedic Foot and Ankle Society (AOFAS). Weight bearing X-rays were used to perform angular measurements and assess the first metatarsophalangeal joint (MTP 1). At follow-up the mean AOFAS score had improved significantly (p < 0.001), but only 55% of the feet showed a perfect realignment of the first ray. Patients with a hallux valgus angle exceeding 30° and pre-existing degenerative changes at the MTP 1 joint displayed inferior clinical results (p < 0.05). Nearly 20% of the patients suffered from pain at the MTP 1 joint. This was clearly attributed to an onset or worsening of distinct radiographic signs of arthritis (p < 0.05) resulting in painfully decreased joint motion. Comparing radiographic appearance three months postoperatively and at follow-up, we found that radiographic criteria (hallux valgus, first intermetatarsal angle, hallux valgus interphalangeus, MTP 1 joint congruency, arthritic lesions at MTP 1) worsened with time.

Fig. 1

Follow-up of a 62-year-old woman presenting with an excellent correction over more than five years. a Preoperative radiograph indicating the metatarsus varus and hallux valgus deformity (first intermetatarsal angle 20 degrees, hallux valgus angle 35 degrees, subluxation of the first metatarsophalangeal joint). b Three months after the operation (first intermetatarsal angle 9 degrees, hallux valgus angle 0 degrees, congruent first metatarsophalangeal joint). c Sixty-one months after the operation (first intermetatarsal angle 9 degrees, hallux valgus angle 0 degrees, congruent first metatarsophalangeal joint)

Fig. 2

CT scan of the distal (transversal plane) metatarsal clearly illustrating the troughing effect

Fig. 3

Follow-up of a 57-year-old woman presenting with a recurrent deformity after 2.4 years. a Preoperative radiograph indicating the metatarsus varus and hallux valgus deformity (first intermetatarsal angle 19 degrees, hallux valgus angle 35 degrees, subluxation of the first metatarsophalangeal joint). b Three months after the operation (first intermetatarsal angle 7 degrees, hallux valgus angle 20 degrees, congruent first metatarsophalangeal joint). c Twenty-nine months after the operation (first intermetatarsal angle 13 degrees, hallux valgus angle 0 degrees, congruent first metatarsophalangeal joint)

Fig. 4

Follow-up of a 71-year-old woman presenting with a recurrent deformity after 4.9 years. a Preoperative radiograph indicating the metatarsus varus and hallux valgus deformity (first intermetatarsal angle 16 degrees, hallux valgus angle 38 degrees, subluxation of the first metatarsophalangeal joint). b Three months after the operation (first intermetatarsal angle 8 degrees, hallux valgus angle 5 degrees, congruent first metatarsophalangeal joint). c Fifty-nine months after the operation (first intermetatarsal angle 12 degrees, hallux valgus angle 20 degrees, incongruent first metatarsophalangeal joint)