SCARF OSTEOTOMY OF THE FIRST METATARSAL FOR CORRECTION OF HALLUX VALGUS, REVIEW OF THE FIRST 56 FEET AT 5 YEARS: TECHNIQUE AND OUTCOME

Abstract

Purpose: We are often tempted to set aside (forget?) a certain number of cases we treated during our “learning curve”. We decided to review our first 56 cases of Scarf osteotomies five years after surgery. We detailed outcome, failures, and current modifications of the surgical technique.

Material and methods: End 1991 beginning 1992, we performed Scarf osteotomy on the first metatarsal in 56 feet for correction of hallux valgus in 33 patients aged 22 to 73 yeas (mean 49.7 years). Metatarso-phalangeal deviation of the first row was 20° to 70° (mean 38.5°) associated with metatarus varus from 12° to 24° (mean 16.6°). There were seven types of hallus valgus. Sesamoid deviation was classed in five categories. There were 20, 15 and 19 Greek, square and Egyptian feet respectively. Associated procedures included 26 osteotomies of the first phalanx of the great toe: twelve for angulation, ten for shortening, and six for angulation and shortening. For the other rows, there were five Gauthier osteotomies of the neck of the second metatarsal for overload syndrome of the second row and one Gauthier osteotomy of the second and third metatarsals for metatarso-phalangeal dislocation.

Results: The patient-assessed subjective result deteriorated with time: excellent 36 (64.2%), good 18 (32.1%), fair 2 (3.7%) at one year and excellent 32 (57.2%), good 15 (26.7%), fair 7 (12.5%), mediocre 1 (2.6%) at five years. Objective results for deformations were: postoperative metatarso-phalangeal angle of the first row 10° to 35° (mean 19°) and metatarsus varus 10° to 18° (mean 11.3°). The morphological result was practically acquired at one year, there was little further accentuation of the deformation with time. There was a clear improvement of the sesamoid position. These positive results cannot mask seven cases with angles of 30° and three with 35°. There was no case of hallux varus in this series. There were two “failures” requiring revision, one for recurrent and bothersome bone deformation and the other for metatarsalgia that developed only after correction of the hallux valgus.

Discussion, conclusion: This review disclosed two problems: insufficient correction and the development of postoperative metatarsalgia. The defective corrections were attributed to insufficient translation in the early cases and to the osteotomy which did not lower (or even raise) the metatarsal head. We have changed the osteotomy line in order to widen the translation surface and also to lower more the metatarsal head.