SLR - November 2015 - Kirten S. Parekh

The Scarf Osteotomy with Minimally Invasive Lateral Release for Treatment of Hallux Valgus Deformity

Reference: Bock P, Kliger R, Kristen KH, Mittlbock M. The Scarf Osteotomy with Minimally Invasive Lateral Release for Treatment of Hallux Valgus Deformity: Intermediate and Long-Term Results. J Bone Joint Surg Am. 2015 Aug 5; 97(15): 1238-45

Scientific Literature Review

Reviewed By: Kirten S. Parekh, DPM
Residency Program: Englewood Hospital and Medical Center

Podiatric Relevance: Numerous osteotomies have been described for the surgical correction of the hallux valgus deformity. In clinical practice, most surgeons limit these to a few procedures, which invariably includes a soft tissue release and a medial exostostomy combined with either proximal or distal osteotomy of the first metatarsal.  Limited information is available regarding mid and long-term results after hallux valgus surgery using the Scarf osteotomy. This study examines the effectiveness and long-term outcomes and recurrence rate with the use of the Scarf osteotomy.

Methods: This study was a retrospective cohort study of one hundred eight patients who underwent a Scarf osteotomy, at an average duration of follow-up of 124 months. Clinical examination before surgery and at the time of final follow-up included an evaluation of range of motion, pain as measured with a visual analog scale, and American Orthopaedic Foot and Ankle Society scores. Radiographic data was evaluated preoperatively, at six weeks postoperatively, and at the time of final follow-up.
 
Results: The median overall AOFAS score improved from 57 points preoperatively to 95 points at the time of final follow-up. All radiographic measurements (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], and sesamoid bone position) showed significant (p < 0.05) improvement at the time of final follow-up compared with preoperatively. The rate of recurrence (an HVA of ≥20°) at the time of final follow-up was 30 percent. The authors were unable to determine if recurrence resulted in functional impairment or any resulting consequences in regards to quality of life.

Conclusions: Previous studies have shown the SCARF osteotomy achieves predictable results, however none of those studies provided long-term post-operative results of the same patient cohort. This study demonstrated that the Scarf osteotomy in combination with an Akin osteotomy and a minimally invasive lateral capsular release resulted in a significant improvement in pain but a relatively high radiographic recurrence rate (30 percent). The authors concluded that recurrence of hallux valgus will most likely happen within the first 1.5 to 2.8 years and although the Scarf osteotomy has been in use for many years with relatively good success, alternative osteotomies should be considered when evaluating patients pre-operatively since sagittal-plan instability may lead to prolonged osseous healing and metatarsal malposition.  Reviewing this publication demonstrates that further high-evidence literature that compares the mid and long term outcomes of the Scarf osteotomy to other procedures (such as the Lapidus, Chevron osteotomy, etc.) is warranted.

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