Tailor's bunion: results of a scarf osteotomy for the correction of an increased intermetatarsal IV/V angle - A report on ten cases with a 1-year follow-up

Introduction: The aim of this study was to analyze clinical and radiologica l results of scarf osteotomy for the correction of an increased intermetata rsal IV/V angle in patients with symptomatic tailors bunion. Patients and m ethods: Between 1997 and 1998, we performed a scarf osteotomy for the corre ction of an increased intermetatarsal IV/V angle OMA) in ten cases. The ind ication was a painful prominence of the fifth metatatarsal with an increase d IMA. Fixation of the osteotomy was performed with two 1.7-mm titanium min iscrews. Mobilization was allowed with full weight-bearing, with a forefoot relief orthosis. Clinical results were evaluated with the forefoot scoring system (ffss). The determination of the TMA was performed with weight-bear ing dorsoplantar radiographs. Results: All osteotomies healed within the fi rst 6 postoperative weeks. Removal of the screws was not necessary in any c ase. The mean preoperative ffss was 29.5 points. At the last follow-up, the mean value of the ffss was 73 points and no patient presented a painful pr ominence above the fifth metatarsal head. The mean IMA was reduced signific antly from 10.3 to 6.8 degrees. Discussion: The scarf osteotomy is an adequ ate surgical procedure for the correction of an increased IMA in patients w ith symptomatic tailor's bunion. surgical treatment is not effective, surgi cal treatment of the underlying pathology may be indicated [2, 3, 4]. Causes of a symptomatic tailors bunion may be a prominent fifth metatarsal head, an increased lateral angulation of the fifth metatarsal shaft, and an increased angle between the IVth and Vth metatarsal [2: 5]. While a promin ent fifth metatarsal head can be treated successfully by partial resection of the head, the two latter deformities can be corrected by a diaphyseal os teotomy [2, 3, 4]. The scarf osteotomy is a z-shaped metatarsal osteotomy, which is commonly u sed for the correction of an increased intermetatarsal I/II angle in patien ts with hallux valgus [1, 8]. Advantage of this procedure is the high prima ry stability [1, 8, 9]. We found no reports in the literature of scarf oste otomy in patients with tailors bunion due to an increased angle between the IVth and Vth metatarsal.