The Use of Osteotomy in the Management of Hallux Rigidus.

Metatarsus elevatus and gastrocnemius tightness contribute to the development of functional hallux rigidus. Although several osteotomies have been described for functional hallux rigidus, certain osteotomies are commonly used in practice for the correction of functional hallux rigidus, a long first metatarsal or an elevated metatarsal, or an unstable tarsometatarsal joint. Proximal plantarflexion osteotomy is used only in the presence of an elevated first metatarsal with a limit to dorsiflexion but without the presence of arthritis at the first metatarsophalangeal joint. In the presence of arthritis at the metatarsophalangeal joint, the decision is between an oblique distal metatarsal osteotomy and the shortening periarticular osteotomy.