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Preserving the Length of the First Metatarsal in Surgical Management of Hallux Valgus
The surgical management of hallux valgus continues to evolve. Typically, a proximal first metatarsal osteotomy has been done when the intermetatarsal angle is greater than 14°. Most osteotomies, however, result in some shortening, which may predispose a patient to transfer metatarsalgia. the use of suture-button fixation between the first and second metatarsals has obviated the need for an osteotomy in many patients. The use of a suture-button construct avoids shortening of the first metatarsal and thereby minimizes the risk of transfer metatarsalgia. In patients in whom the use of a suture button is not possible, an opening wedge osteotomy of the proximal first metatarsal also will avoid shortening while allowing for correction of the intermetatarsal deformity. The main indication for hallux valgus correction with an opening wedge osteotomy is an elevated intermetatarsal angle (> 14°), especially if the deformity is rigid. In addition to preserving length and thereby minimizing transfer metatarsalgia, both techniques allow adjustable correction of the intermetatarsal angle intraoperatively. This chapter focuses on the surgical techniques of suture-button fixation and opening wedge osteotomy in patients with hallux valgus.