Shaft osteotomies in hallux valgus reduction.

Osteoplasty of the first metatarsal is a form of "plastic surgery" of bone. It is technically demanding and requires a thorough knowledge of anatomy and morphology of bone. Direct dissection techniques are recommended rather than layering, which unnecessarily devascularizes the tissues. Understanding the principles of osteosynthesis and absolute stability is important and will allow the surgeon confidence in knowing that these operative procedures can be performed safely with a high degree of predictability in the correction. These procedures open a new area for consideration in the management of the hallux valgus deformity with intermediate IM angle deformities.