Proximal metatarsal osteotomy and distal soft tissue reconstruction as treatment for hallux valgus deformity

The correction of a hallux valgus deformity with a proximal 1(st) metatarsal osteotomy and distal soft tissue repair is achieved with a three-incision technique. A lateral soft tissue release and reconstruction at the first metatarsophalangeal joint releases contracted structures including the lateral capsule, the transverse inter-metatarsal ligament and the conjoint adductor tendon. Rarely is the lateral sesamoid excised. Through a medial incision, the medial eminence or exostosis is resected. The sesamoids are realigned and the medial capsule is reefed. With a third incision, a proximal first metatarsal osteotomy is performed that corrects a widened 1-2 intermetatarsal angle. With correction of the hallux valgus and the 1-2 intermetatarsal angle, pronation of the hallux is corrected. This correction is routinely used for hallux valgus deformities characterized by subluxation of the metatarsophalangeal joint. In the presence of a mild hallux valgus deformity an osteotomy may not be necessary. With degenerative arthritis or a congruent metatarsophalangeal joint, alternative surgical procedures are indicated.