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The Scarf Osteotomy: A Salvage Procedure for Recurrent Hallux Valgus in Selected Cases

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The Scarf osteotomy was described as a technique to correct a metatarsus primus varus in primary hallux valgus surgery, but it is unclear whether the technique could correct recurrent hallux valgus when an initial procedure failed to provide any or an adequate lateral displacement of the metatarsal head.

Questions/purposes

We asked whether the Scarf osteotomy could reduce pain, improve the AOFAS score, reduce the deformity, and prevent further recurrence when used as a revision procedure.

Patients and Methods

Of 41 patients (45 feet) we treated for failed initial operations, we retrospectively reviewed 35 (39 feet) who underwent a Scarf osteotomy. We administered a VAS for pain and the AOFAS score preoperatively and postoperatively. Preoperative and postoperative radiographs were taken to assess the hallux valgus angle [HVA] and intermetatarsal angle [IMA]. The minimum followup was 24 months (mean, 42 months; range, 24–89 months).

Results

The mean VAS for pain improved from 5.9 to 0.4 points. The mean AOFAS score improved from 56 to 90 points. The radiographic evaluation showed improvement of the mean HVA from 30° to 8° and improvement of the IMA from 13° to 4°. Complications included one asymptomatic recurrence with a 20°-HVA, one overcorrection with a 3°-varus deformity, and pain attributable to irritation caused by screws in five patients.

Conclusions

As a revision procedure the Scarf osteotomy clinically and radiographically corrected recurrent hallux valgus recurrence in most patients.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank B. Izay for helping with the statistical evaluation, M. Pittermann for helping with evaluation of the radiographic results, and K. Chong with English translation and wording.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Danube Hospital, Vienna, Langobardenstrasse 122, 1220, Vienna, Austria

    Peter Bock MD, Ulrich Lanz MD, Andreas Kröner MD, Georg Grabmeier MD & Alfred Engel MD, PhD

Authors
  1. Peter Bock MD
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  2. Ulrich Lanz MD
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  3. Andreas Kröner MD
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  4. Georg Grabmeier MD
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  5. Alfred Engel MD, PhD
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Corresponding author

Correspondence to Peter Bock MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with the ethical principles of research, and that informed consent for participation in the study was obtained.

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Bock, P., Lanz, U., Kröner, A. et al. The Scarf Osteotomy: A Salvage Procedure for Recurrent Hallux Valgus in Selected Cases. Clin Orthop Relat Res 468, 2177–2187 (2010). https://doi.org/10.1007/s11999-010-1363-z

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  • DOI: https://doi.org/10.1007/s11999-010-1363-z

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