Scarf osteotomy for the treatment of moderate to severe hallux valgus: Analysis of predictors for midterm outcomes and recurrence

Background: Controversies remain regarding the predictors for outcomes and recurrence after scarf osteotomy for hallux valgus deformity. Methods: Sixty-two patients (70 feet) underwent scarf osteotomy for hallux valgus deformity. The radiological angles, tibial sesamoid position, articular congruence, demographics, comorbidities, AOFAS, VAS and SF-12 scores, and the postoperative compliance were tested as predictors for outcomes and recurrence. Results: After a mean 38 ± 15.4 months follow-up, all of the radiological angles, the total AOFAS, PCS-12 and VAS scores significantly improved (all P < 0.001). Preoperative MCS-12 was directly related to the total postoperative AOFAS score (P = 0.003). A higher number of cardiovascular risk factors negatively affected the postoperative total AOFAS score, VAS and PCS-12 (β = −3.42, P = 0.030; β = 0.262, P = 0.022; β = −0.181, P = 0.025, respectively). The BMI influenced postoperative PCS-12 (β = −0.244, P = 0.002). Preoperative HVA was directly related to postoperative DMAA (P = 0.002) and tibial sesamoid position (P = 0.005). Preoperative joint incongruence and postoperative noncompliance were associated with recurrence (P = 0.043 and P = 0.035, respectively). Conclusions: Satisfactory results can be expected after scarf osteotomy. Higher BMI and number of cardiovascular risk factors, and low mental status should be carefully considered when counselling patients for this procedure. Adherence to postoperative care instructions influences deformity recurrence. © 2019 European Foot and Ankle Society