The pivotal metatarsal osteotomy: a modification of the metatarsal metaphyseal osteotomy.

The presence of cancellous bone determines the choice of location for osteotomies in the metatarsals. The head and base have good cancellous bone, whereas the shaft has cortical bone and a medullary canal which make it a poor choice of osteotomy site. Many practitioners are now using a transverse metaphyseal osteotomy; however, the authors choose the pivotal metaphyseal osteotomy as the procedure of choice using a 10- or 12-mm Pivotal Osteotomy Blade attached to an oscillating power source.