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Scarf Osteotomy: For large bunions, joint fusion is not the only option.

Scarf Osteotomy:  For large bunions, joint fusion is not the only option.

There are numerous ways to repair a bunion deformity. The most common procedure performed today is called an Austin bunionectomy, which utilizes at V shaped bone cut. This procedure has utility for reducing small to moderate bunions, but cannot reduce larger deformities 

When patients suffer from a moderate to large bunion deformities a procedure called a SCARF bunionectomy can be employed. This procedure uses a Z shaped osteotomy, or bone cut within the first metatarsal (see SCARF Bunionectomy and Akin Osteotomy video).  

The SCARF procedure can also be used in patients with large bunions who cannot undergo the more aggressive fusion surgery called a Lapidus due to age or poor bone quality. Also, older or unstable patients can bear weight on surgical foot after this procedure, where fusion surgery does not allow activity on foot immediately after surgery. Surgeons who have not been trained on the SCARF often opt to perform a more aggressive fusion surgery (Lapidus). This is not necessary in many cases.   

Advantages of the SCARF

  • Early patient weightbearing
  • Early range of motion of joint – two weeks post-op
  • More stable bone cut than Austin, less risk of displacement and need for revision surgery
  • Can correct larger deformities without fusion surgery that requires nonweightbearing
  • Allows for transition out of walking boot at 4 weeks post-op into athletic shoe
  • Avoids fusion surgery which can fail to heal in older patients
  • Can be utilized when reducing bunion with a cosmetic incision to medial foot (instep)

If you have a moderate to large bunion deformity, the SCARF can be a great option for you.