Proximal opening-wedge osteotomy of the first metatarsal for correction of hallux valgus

Osteotomy of the proximal metatarsal in combination with a distal soft tissue procedure for the correction of moderate to severe hallux valgus deformity is commonly performed. All described techniques have complications such as non-union and malunion, and many are extremely technically demanding. The purpose of this study is to review the results of a novel technique for the correction of hallux valgus, an opening-wedge osteotomy of the proximal first metatarsal with plate fixation. A review was performed of the results of 23 patients who underwent correction of hallux valgus with proximal metatarsal opening-wedge osteotomy, in combination with a distal soft tissue procedure and exostectomy, if indicated. All osteotomies were secured with plate fixation on the medial side. Indications for surgery included a painful bunion for greater than one year and the failure of nonoperative treatment. Mean corrections of 15 degrees and 7 degrees were achieved for the hallux valgus and 1-2 intermetatarsal angles, respectively. Four complications occurred, including one wound dehiscence, two incidences of drifting of the hallux valgus angle, and one delayed union. We find the opening-wedge osteotomy of the proximal first metatarsal to be a technically straightforward procedure for correcting moderate to severe hallux valgus. The correction obtained is comparable to other described techniques with a complication rate equal to or lower than most published data at this time.