Closing adductory wedge osteotomy of proximal phalanx of hallux. Primarily indicated for hallux valgus interphalangeus.
Wedge of bone is removed from base of proximal phalanx, leaving a small hinge of cortical bone on the lateral side reduced the abducted alignment of the hallux on the metatarsal.
Can be combined with derotation (use an oblique osteotomy to remove plantar/medial wedge varus stress to derotate)
• Basal osteotomy: indicated for shorter great toe; performed through proximal metaphysis
• Shaft osteotomy
Rarely used as an isolated procedure as does not address ‘bunion’ deformity (does give the appearance of a ‘straighter’ hallux)
Indication – no degenerative disease in first MPJ; moderate to severe deformity – especially if DASA is increased (especially if hallux interphalangeal abductus is present)
• Incision midline over base of proimal phalanx
• Dissect periosteum to explore base of phalanx
• Reflect EDL and EHL tendons
• Closing wedge osteotomy with base of wedge 5-7mm distal for MPJ
• Fix with k-wire
Complications- injury to flexor hallucius longus tendon;