Metatarsal osteotomies: which operation?

Surgical correction of hallux valgus by metatarsal osteotomy should aim to restore normal foot anatomy. The operation selected, therefore, needs to be a compromise between biologic and biomechanical considerations. Particular attention should be addressed to the preoperative length and direction of the first metatarsal, as well as the alignment of the first metatarsophalangeal joint. Reducing an already short first metatarsal should be avoided. Realignment of a subluxed first metatarsophalangeal joint requires medial capsular plication, and marked metatarsus primus varus warrants a basal osteotomy.