The SERI distal metatarsal osteotomy and Scarf osteotomy provide similar correction of hallux valgus

Clin Orthop Relat Res. 2013 Jul;471(7):2305-11. doi: 10.1007/s11999-013-2912-z. Epub 2013 Mar 14.


Background: Ideal surgical treatment for hallux valgus is still controversial. A traditional distal metatarsal osteotomy with rigid fixation (Scarf procedure) and a more minimally invasive approach to a distal metatarsal osteotomy, termed SERI (Simple, Effective, Rapid, Inexpensive), have proven successful with short-term followup. However, no data are available directly comparing the two procedures.

Questions/purposes: We performed a prospective randomized trial to determine which technique (SERI or Scarf) was associated with (1) better functional outcomes, (2) better radiographic correction, and (3) fewer complications at 2 and 7 years followup.

Methods: Twenty patients, 53 ± 11 years of age, with bilateral hallux valgus, clinically and radiographically similar, underwent bilateral surgery with Scarf on one side and SERI on the other, at random. Clinical (AOFAS score) and radiographic assessments were considered before surgery, and at 7 years followup.

Results: SERI and Scarf techniques provided correction of the hallux valgus angle, intermetatarsal angle, and distal metatarsal angle in the range of normal. Both led to similar clinically important improvements in the AOFAS. No differences were observed between the groups. All osteotomies healed, and two patients who underwent the Scarf procedure required hardware removal. Reduction of ROM with respect to preoperative was observed in three patients for SERI and three patients for Scarf procedures.

Conclusions: Scarf and SERI techniques resulted in effective correction of hallux valgus with similar outcomes, however the SERI technique required a shorter skin incision, less surgical time, less expensive fixation device, and was without residual pain attributable to hardware.

Level of evidence: Level II, prospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Biomechanical Phenomena
  • Bone Screws
  • Female
  • Hallux Valgus / diagnostic imaging
  • Hallux Valgus / physiopathology
  • Hallux Valgus / surgery*
  • Humans
  • Italy
  • Metatarsal Bones / diagnostic imaging
  • Metatarsal Bones / physiopathology
  • Metatarsal Bones / surgery*
  • Metatarsophalangeal Joint / diagnostic imaging
  • Metatarsophalangeal Joint / physiopathology
  • Metatarsophalangeal Joint / surgery*
  • Middle Aged
  • Osteotomy / adverse effects
  • Osteotomy / instrumentation
  • Osteotomy / methods*
  • Pain, Postoperative / etiology
  • Prospective Studies
  • Radiography
  • Range of Motion, Articular
  • Recovery of Function
  • Time Factors
  • Treatment Outcome