Distal osteotomy of the first metatarsal bone with plantarization for the treatment of hallux limitus due to metatarsus primus elevatus

Objective Joint-preserving procedure with plantarization of the 1st metatarsal and improvement of range of motion. Indications Mild and moderate arthrosis of the 1st metatarsophalangeal joint with pain and shoe discomfort due to elevation of 1st ray and failed conservative treatment. Contraindications Severe degenerative conditions 1st metatarsophalangeal joint with significant loss of range of motion preoperatively. General contraindications for surgical treatment/anesthesia. Surgical technique Dorsomedial approach to 1st metatarsophalangeal joint, mild cheilectomy and arthrolysis, v-shaped osteotomy of metatarsal 1 from dorsal with plantarization of the metatarsal head, screw fixation from proximal dorsal to distal plantar. Postoperative management Full weightbearing in rocker bottom shoe for 6 weeks. Results Improvement of range of motion from 35 degrees dorsal extension to 50 degrees in all cases after 6 months. Reduction of painful movement from VAS 6-7 to VAS 2-3 in 80% of patients.