[Osteotomy of the first ray in the treatment of hallux valgus]

An osteotomy of the first row for the treatment of hallux valgus is indicated for younger patients with minor to moderate valgus deformation and only minor arthritic changes in the first metatarsophalangeal joint. The osteotomy has two prominent goals: Correction of the deformity and restoration of muscle function and muscular balance. Especially the later seems to be essential for preventing failures in the long term. Osteotomies can be carried out on os cuneiforme mediale, metatarsal bone (proximal, shaft, subcapital) and phalanx. The cuneiforme osteotomy isn't recommended because of alterations in the joint between the medial and intermedium cuneiforme. Osteotomies of the proximal metatarsal bone are rarely performed and mostly combined with an arthroplastic procedure of the metatarsophalangeal joint. The disadvantage of a shaft osteotomy (Ludloff's osteotomy) is the long time for healing of the osteotomy of diaphysis of the metatarsal bone. Subcapital osteotomies are most frequently performed. With a subcapital osteotomy you can correct more deformities than with the other osteotomies. The phalangeal osteotomy is indicated just in special cases. The combination of a subcapital and a phalangeal osteotomy is recommended by Magerl in order to reduce the failure rates.