Proximal metatarsal osteotomies: A comparative geometric analysis conducted on sawbone models

We evaluated the change in position of the first metatarsal head using a three-dimensional digitizer on sawbone models. Crescentic, closing wedge, oblique shaft (Ludloff 8degrees and 16degrees), reverse oblique shaft (Mau 8degrees and 16degrees), rotational "Z" (Scarf), and proximal chevron osteotomies were performed and secured using 3-mm screws. The 16degrees Ludloff provided the most lateral shift (9.5 mm) and angular correction (14.5degrees) but also produced the most elevation (1.4 mm) and shortening (2.9 mm). The 8degrees Ludloff provided lateral and angular corrections similar to those of the crescentic and closing wedge osteotomies with less elevation and shortening. Because the displacement osteotomies (Scarf, proximal chevron) provided less angular correction, the same lateral displacement, and less shortening than the basilar angular osteotomies, based upon this model they can be more reliably used for a patient with a mild to moderate deformity, a short first metatarsal, or an intermediate deformity with a large distal metatarsal articular angle. These results can serve as recommendations for selecting the optimal osteotomy with which to correct a deformation.