- The Problem – Etiology
- Typical Treatments
The Problem – Etiology
Deformities of the 1st ray are caused by:
Faulty foundation proximally compounded by abnormal distal-lateral to proximal-medial forces,
leading to excessive metatarsal motion.
Maybe the metatarsal bone is too long, or too short.
Talotarsal joint subluxation pushes the metatarsal bone dorsomedially.
Rarely are 1st ray deformities caused by a crooked 1st metatarsal.
Typical Treatments
Conservative care
– does not address the underlying deformity
– allows the progression of the deformity
– may give a false sense of correction
1st metatarsal surgery
– alters the structure of the 1st metatarsal
– does not address the underlying proximal and/or distal deformity
– allows the progression of the deformity
– may give a false sense of correction
1st MCJ end-to-end arthrodesis
– addresses the apex of the deformity
– may lead to significant shortening of the 1st metatarsal
– may lead to metatarsalgia sub 2nd and 3rd metatarsal heads
– may require additional surgery
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