title: Proximal metatarsal osteotomy and distal soft tissue reconstruction as treatment for hallux valgus deformity.
abstract: 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.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Coughlin
authors.forename: Speight
authors.initials: S
authors.lastname: Grimes
mesh_terms: D000328:Adult; D000758:Anesthesia; D002648:Child; D006215:Hallux Valgus / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D008023:Ligaments, Articular / Q000601:surgery; D008684:Metatarsus / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D014945:Wound Healing