The Scarf Osteotomy
consists of a horizontal cut and two transversal cuts
of the first metatarsal, allowing for a broad range of
angular corrections
First, a medial capsulotomy and a lateral
release is performed (1)
An inter-aticular or inter-metatarsal
approach is advised
The lateral sesamoid bone is dissected
free by making a longitudinal incision between
the lateral sesamoid and the lateral suspensory
collateral ligament
This incision is extended anterior and
the adductor hallucis is released from its
phalangeal insertion. This way, after lateral
displacement of the metatarsal fragment,
the sesamoids will be placed under the metatarsal
head. (2)
The exostosectomy should be as minimal
as possible
The longitudinal resection is performed
in alignment of the medical aspect of
the metatarsal shaft
The proximal midplantar dissection provides
a quasi complete exposure of the midplantar
margin and the plantar surface. This view
is essential for the realization of the
SCARF osteotomy.
The longitudinal cut is performed parallel
to the medial border as well as to the
plantar surface (3)
The transversal cuts are chevron like
cuts (45° angle with the longitudinal
cut), which are perpendicular to the second
metatarsal (slightly backwards) (4, 5)
The dorsal aspect of the distal transversal
cut should be 5 mm proximal to the cartilage
The proximal transversal cut is placed
10 mm from the cuneo metatarsal joint (6)
