Scarf osteotomy and forefoot surgery planning

The scarf osteotomy is an old, versatile and useful osteotomy, now well recognised as reliable and effective to contribute to the correction of the majority of hallux valgus cases. The correction of severe deformities with a metatarsus varus angle > 18° and Distal Metatarsal Articular Angle (DMAA) >15° remains challenging. In order to improve 3D displacements of the metatarsal head, scarf design became more oblique, shorter, and if necessary a distal medial wedge was removed from the plantar fragment to supinate the head . In case of large horizontal translation, there is no place to put any screw. Therefore a transosseous absorbable suture was placed, in order to obtain a constrained fixation distally, and an autologous bone graft was impacted proximally (the distal wedge of the dorsal M1 fragment). This procedure has been used to replace the screws since 1999. Immediate weight-bearing was allowed with a total contact cast sole for one or two weeks, followed by a postoperative shoe for a month.