Opening Wedge Osteotomy of the First Metatarsal Base: A Technique for Correction of Metatarsus Primus Varus Using a New Titanium Opening Wedge Plate

Although not without controversy in technique and fixation methods, the opening-base wedge can be a successful procedure for moderate-to-severe hallux valgus deformities with significant metatarsus primus varus while preserving relative metatarsal length. Literature regarding the opening-base wedge has been limited and somewhat unfavorable. It is our purpose to present a promising new technique combining the modified McBride bunionectomy with a proximal first metatarsal opening-base wedge osteotomy. Using a standardized technique, we were able to achieve an efficient, reproducible, and stable construct, thereby minimizing intraoperative complications and postoperative morbidity. Fixation is achieved in each case using a new titanium plate designed for opening proximal osteotomies. Because of the stable fixation construct, patients are able to progress to protected weightbearing status much sooner than with previously described base wedge procedures, thus making this procedure more tolerable as well. The opening-base wedge procedure can be a reliable addition to the armamentarium of surgical options for proximal hallux valgus correction. To our knowledge, no previous studies have been published regarding this method.

Keywords:  base wedge osteotomy , bunionectomy , first metatarsal , hallux valgus , metatarsus primus varus , proximal metatarsal osteotomy , opening base wedge