What is a Scarf Osteotomy?

The scarf osteotomy is a surgical procedure performed to correct a deformity of the foot known as a bunion. A bunion is a bony lump that can develop on the foot when the largest toe is forced inward at an angle. Bunions can run in families but are mainly found in women who wear shoes that are too narrow in the toe region. When bunions become painful and the pain cannot be alleviated with wide-toed shoes, a surgeon may need to perform a scarf osteotomy.

The word scarf is a term used in carpentry to describe the notching of two pieces of wood so that they interlock and form a strong bond. This notching technique is the basis of the scarf osteotomy procedure. Specifically, the long bone, or metatarsal, of the first toe is sliced horizontally and two transverse cuts or notches are made at each end of the bone. The lower piece of the first metatarsal is moved inward to reduce the angle between the first and second metatarsals and bring the toes closer together.

Once the pieces are in their new position, the two sections of the first metatarsal bone are connected with two small screws. Reducing the angle between the first and second metatarsals also reduces the size of the bunion. Any bone still protruding in the area of the bunion can then be shaved off and given a smooth surface.

Scarf osteotomy is considered for those patients who complain of joint pain or who are unable to wear normal shoes. A surgeon typically will order pre-operative x-rays in order to measure various angles between the first and second toes. It is the goal of this surgery to reduce those angles and draw the long bone back to a normal angle.

Typically, a patient is admitted to the hospital and the surgery is performed while the patient is under general anesthesia. A hospital stay of one to three nights is usually required depending on whether the patient has the scarf osteotomy done on one or both feet. Recovery from the surgery and walking on the foot usually occur within one to two weeks, but a full reduction of swelling may take up to three months. The patient usually will be monitored with follow up x-rays during recovery.

The scarf osteotomy procedure has proven to be successful and is used routinely to correct bunions. It is known to have few complications and a low rate of recurrence of the bunion. The patient can usually resume normal activities in a short period of time.