Outcomes after scarf osteotomy for treatment of adult hallux valgus deformity.

Background: Many procedures have been developed to correct hallux valgus deformity using distal soft tissue realignment, metatarsal osteotomy, and periodically, a proximal phalanx osteotomy (Akin). The ideal metatarsal osteotomy allows for varying degrees of correction with reliable improvement in deformity and patient satisfaction.
Questions/purposes: We evaluated the results after scarf osteotomy with respect to American Orthopaedic Foot and Ankle Society (AOFAS) scores, patient satisfaction, radiographic results, and complications.
Patients and Methods: We evaluated 29 patients (34 feet) during an 18-month period who underwent a unilateral scarf osteotomy combined with distal soft tissue realignment. Preoperative and postoperative AOFAS scores, patient satisfaction, and radiographic data were used to evaluate the effectiveness of the procedure. Complications were recorded. Minimal followup was 12 months (average, 26.4 months; range, 12-48 months).
Results: The mean AOFAS scores improved from 61.5 to 90.3. At final followup, 94% of patients were satisfied with the surgery. The hallux valgus angle improved from 34.6° to 14.9° and the intermetatarsal angle improved from 15.8° to 7.2° postoperatively. A combined Akin osteotomy was performed in only four cases. Complications included superficial wound infection (one), recurrence (two), and troughing (three).
Conclusions: Our results suggest the scarf osteotomy produces improved AOFAS scores, high percentage of patient satisfaction, and effective correction of hallux valgus deformities. Using our scarf technique of rotation combined with translation minimizes the need for an Akin osteotomy while still obtaining good correction and avoids associated complications described in the literature.
Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.