Dorsomedial Approach to the First MetatarsalThe dorsomedial approach to the first metatarsal provides excellent exposure of the shaft of the first metatarsal bone. Its use is largely confined to the open reduction and internal fixation of metatarsal shaft fractures, but can also be used for elective osteotomy in posttraumatic deformity or the correction of hallux valgus. Its other uses include the following:
Drainage of infection
Excision of bone tumors affecting the first metatarsal
Position of the Patient
Place the patient supine on the operating table (see Fig. 1-1). Partially exsanguinate the foot either by elevating it for 3 to 5 minutes or by applying a soft rubber bandage loosely to the foot and binding it firmly to the calf. Then inflate a thigh tourniquet.
Landmarks and Incision
Palpate the dorsomedial surface of the first metatarsal, which is subcutaneous and easily palpated. Identify the metatarsophalangeal joint of the hallux by moving the joint. The metatarsomedial cuneiform joint may be difficult to palpate; if the incision is to be used for proximal osteotomy, position of the joint may need to be confirmed by radiography.
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