01/04/2023    David Secord, DPM

Study of 1,583 Scarf Osteotomies Uncovers Outcome Stats (Elliot Udell, DPM)

I appreciate the post from Dr. Udell on the Scarf
osteotomy and the call for a wider examination of
bunion procedures and surgeon skills skewing
results. I have amended my approach to 1st ray
pathologies to just three procedures: Primarily,
the Scarf; Secondarily, the Lapidus (in cases of
either an IM over 18 degrees, or a gorilliform or
diseased 1st metatarsal/medial cuneiform
articulation; and the Fowler (in cases where the IM
angle is over 18 degrees and the 1st
metatarsal/medial cuneiform articulation is
normal). I commonly graft my Lapidus procedures to
avoid over-shortening of the 1st ray and transfer
to the 2nd met head. I’ve corrected as much as a 45
degree IM angle with the Fowler.

Although a major undertaking, a comparison of
complications between commonly employed techniques
would be monumental in scope and implications. When
I’ve tried to show people how to do the Scarf (as
taught to me by Lowell Weil, Sr., although I’ve
modified it), I warn them that the most difficult
aspect to master is the lateral release, which is
done from the straight medial incisional approach
via plantarflexing the hallux to sling the
sesamoidal apparatus and the release is done by a
#64 beaver blade between the sesamoids and the met
head.

The straight, medial approach with closure via
Monocryl and Steri-strips allows for excellent
cosmesis and the Scarf is a stable enough construct
in that it would allow the possibility of immediate
weight-bearing. Although Dr. Weil did bilateral
corrections, I like to have the patient get by with
one good wheel post-op. I’ve done the contralateral
extremity within 2 weeks of the first procedure,
but prefer to wait until I see some evidence of
clinical union on films (4-6 weeks minimum). All of
these guidelines are fluid and determined by
patient demographics.

David Secord, DPM, McAllen, TX

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