Journal List > J Korean Foot Ankle Soc > v.21(3) > 1043452

J Korean Foot Ankle Soc. 2017 Sep;21(3):93-97. Korean.
Published online September 15, 2017.
Copyright © 2017 Korean Foot and Ankle Society
The Treatment for Hallux Valgus with Scarf Osteotomy in Elderly Patients with Osteoporosis
Seung Hyun Hwang, Su Chan Lee, Chang Hyun Nam, Ji-Hoon Baek and Hye Sun Ahn
Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Korea.

Corresponding Author: Seung Hyun Hwang. Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120 Sinmok-ro, Yangcheon-gu, Seoul 07999, Korea. Tel: 82-2-3219-9229, Fax: 82-2-2061-8605, Email:
Received April 27, 2017; Revised July 13, 2017; Accepted July 14, 2017.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



The aim of this study was to evaluate the radiological and clinical outcomes of scarf osteotomy for hallux valgus (HV) deformity in elderly patient with osteoporosis.

Materials and Methods

A total of 58 elderly patients (mean age, 72.6 years) underwent scarf osteotomy for HV deformity between 2008 and 2015. The mean follow-up period was 24.4 months. Of the 58 patients, 42 were diagnosed with osteoporosis and 16 were diagnosed as normal. The radiological and clinical outcomes were assessed preoperatively, postoperatively, and at final follow-up, including HV angle, intermetatarsal (IM) angle, American Orthopaedic Foot and Ankle Society (AOFAS) score, patient satisfaction, visual analogue scale (VAS), and complication.


There was no significant difference in HV angle and IM angle between the osteoporosis group and normal bone mineral densitometry group at all time points, preoperative, postoperative, and final follow-up. Moreover, there was no statistically significant difference between the two groups with respect to the AOFAS score and VAS evaluations. In the osteoporosis group, the mean HV angle improved from 36.7° preoperatively to 11.3° at the time of final follow-up, and the mean IM angle improved from 13.2° to 5.7°. The mean AOFAS score improved from 52.6 preoperatively to 89.1 at the time of final follow-up. With respect to satisfaction, 83.4% of patients were very satisfied or satisfied. There were no serious complications, and all cases showed complete union at the osteotomy site.


We believed that scarf osteotomy is a safe, effective procedure for the correction of elderly patients with osteoporosis.

Keywords: Osteoporosis; Hallux valgus; Scarf osteotomy


Figure 3
Postoperative radiograph at 27-month follow-up.
Click for larger imageDownload as PowerPoint slide


Table 1
Comparison of Demographic, Radiological and Clinical Outcomes between Two Groups
Click for larger imageClick for full tableDownload as Excel file

Table 2
Radiographic and Clinical Outcomes in Osteoporosis Group
Click for larger imageClick for full tableDownload as Excel file

Table 3
Comparison of Overall Satisfaction between Two Groups
Click for larger imageClick for full tableDownload as Excel file


Conflict of interest:None.

Financial support:None.

1. Cho NH, Kim S, Kwon DJ, Kim HA. The prevalence of hallux valgus and its association with foot pain and function in a rural Korean community. J Bone Joint Surg Br 2009;91:494–498.
2. Nguyen US, Hillstrom HJ, Li W, Dufour AB, Kiel DP, Procter-Gray E, et al. Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study. Osteoarthritis Cartilage 2010;18:41–46.
3. Roddy E, Zhang W, Doherty M. Prevalence and associations of hallux valgus in a primary care population. Arthritis Rheum 2008;59:857–862.
4. Johnson JE, Clanton TO, Baxter DE, Gottlieb MS. Comparison of Chevron osteotomy and modified McBride bunionectomy for correction of mild to moderate hallux valgus deformity. Foot Ankle 1991;12:61–68.
5. Trnka HJ, Hofstaetter SG, Hofstaetter JG, Gruber F, Adams SB Jr, Easley ME. Intermediate-term results of the Ludloff osteotomy in one hundred and eleven feet. J Bone Joint Surg Am 2008;90:531–539.
6. Jeong BO, Lee SH. Treatment for hallux valgus with chevron metatarsal osteotomy in patients over 60 years old. J Korean Foot Ankle Soc 2012;16:223–228.
7. Yoo WJ, Chung MS, Baek GH, Yu CH, Moon HJ. Distal chevron osteotomy for moderate to severe hallux valgus deformity in patients aged 50 or older. J Korean Orthop Assoc 2008;43:445–450.
8. Park HS, Park HT, Lee GS, Kim SH, Lee KT. Operative treatment for hallux valgus with proximal metatarsal osteotomy in patients over 55 years old. J Korean Foot Ankle Soc 2005;9:69–73.
9. Kelikian H. In: Hallux valgus, allied deformities of the forefoot and metatarsalgia. Philadelphia: Saunders; 1965. pp. 1-5.
10. Hofstaetter SG, Riedl M, Glisson RR, Trieb K, Easley ME. The influence of patient age and bone mineral density on osteotomy fixation stability after hallux valgus surgery: a biomechanical study. Clin Biomech (Bristol, Avon) 2016;32:255–260.
11. Coughlin MJ. Hallux valgus. Instr Course Lect 1997;46:357–391.
12. Schneider W. Influence of different anatomical structures on distal soft tissue procedure in hallux valgus surgery. Foot Ankle Int 2012;33:991–996.
13. Choi YR, Lee HS, Jeong JJ, Kim SW, Jeon IH, Lee DH, et al. Hallux valgus correction using transarticular lateral release with distal chevron osteotomy. Foot Ankle Int 2012;33:838–843.
14. Park HW, Lee KB, Chung JY, Kim MS. Comparison of outcomes between proximal and distal chevron osteotomy, both with supplementary lateral soft-tissue release, for severe hallux valgus deformity: a prospective randomised controlled trial. Bone Joint J 2013;95:510–516.
15. Potenza V, Caterini R, Farsetti P, Forconi F, Savarese E, Nicoletti S, et al. Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus. Foot Ankle Int 2009;30:512–516.
16. Barouk LS. Scarf osteotomy for hallux valgus correction. Local anatomy, surgical technique, and combination with other forefoot procedures. Foot Ankle Clin 2000;5:525–558.
17. Robinson AH, Bhatia M, Eaton C, Bishop L. Prospective comparative study of the scarf and Ludloff osteotomies in the treatment of hallux valgus. Foot Ankle Int 2009;30:955–963.
18. Perugia D, Basile A, Gensini A, Stopponi M, Simeonibus AU. The scarf osteotomy for severe hallux valgus. Int Orthop 2003;27:103–106.
19. Wagner A, Fuhrmann R, Abramowski I. Early results of scarf osteotomies using differentiated therapy of hallux valgus. Foot Ankle Surg 2000;6:105–112.
20. Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 1993;341:72–75.
21. Yates AJ, Ross PD, Lydick E, Epstein RS. Radiographic absorptiometry in the diagnosis of osteoporosis. Am J Med 1995;98:41S–47S.
22. Hasselman CT, Vogt MT, Stone KL, Cauley JA, Conti SF. Foot and ankle fractures in elderly white women. Incidence and risk factors. J Bone Joint Surg Am 2003;85:820–824.
23. Bock P, Kristen KH, Kröner A, Engel A. Hallux valgus and cartilage degeneration in the first metatarsophalangeal joint. J Bone Joint Surg Br 2004;86:669–673.
24. Roukis TS, Weil LS, Weil LS, Landsman AS. Predicting articular erosion in hallux valgus: clinical, radiographic, and intraoperative analysis. J Foot Ankle Surg 2005;44:13–21.
25. Doty JF, Coughlin MJ, Schutt S, Hirose C, Kennedy M, Grebing B, et al. Articular chondral damage of the first metatarsal head and sesamoids: analysis of cadaver hallux valgus. Foot Ankle Int 2013;34:1090–1096.