Literature Review | Scarf Osteotomy for the Correction of Tailor's Bunion: A Systematic Review | Find Your Stride | Edinburgh Podiatrist

Introduction

Tailor's bunions, also known as bunionettes, are a prominence seen at the fifth metatarsophalangeal (MTP) joint accompanied by adduction of the small toe. The condition often leads to discomfort and functional limitations, posing challenges for patients, especially those who do not respond to conservative treatment. Despite the absence of a universally accepted gold standard for the surgical management of tailor's bunions, the scarf osteotomy has emerged as a promising approach due to its potential versatility and effectiveness. Today’s blog post provides an exploration of a recent systematic review conducted by Mr. Christopher Coll and Mr. Ian Beech (2023) on the efficacy of the scarf osteotomy as a corrective measure for tailor’s bunions.

Bilateral tailor's bunions or bunionettes - not the position of the smallest toes

Methods

To better understand the efficacy of scarf osteotomy in treating tailor's bunions, the author's conducted a comprehensive search of relevant electronic databases gathering studies published between 2000 and 2021. Eligible studies were required to present outcomes from both the perspective of surgeons and patients. Each study underwent a methodological quality assessment and risk of bias evaluation. In total, four small-scale case series studies satisfied the inclusion criteria for this systematic review.

Results

Analysis of the included studies indicated a statistically significant reduction in the 4th inter-metatarsal angles, alongside improvements in both clinical outcomes and patient-reported measures of satisfaction. A complication rate of 15% was observed; however, recurring plantar hyperkeratosis (callus) was noted as the most common complication. One specific study highlighted a possible connection between hyperkeratosis and pes cavus (high-arched foot). Despite the positive findings, all four studies displayed considerable methodological limitations and a high risk for bias.

Conclusion

The scarf osteotomy seems to represent an effective option for the correction of tailor's bunions, yielding improvements in both clinical outcomes and patient satisfaction alongside a low complication rate. However, foot and ankle surgeons are advised to discuss potential risks with patients, particularly concerning the recurrence of hyperkeratosis, which may be a significant post-operative concern. It is also important to mention that the research studies included within this literature review were not without their limitations, and were published despite a high risk of bias.

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