Dome-Based Modification of Double Osteotomy for the First Metatarsal: Complete Dome for Proximal Metatarsal and Dorsal Cortex Dome-Plantar Cortex Axial Osteotomy for Distal Metatarsal

Congruence of the first metatarsophalangeal joint in hallux valgus (HV) is often associated with an increased distal metatarsal articular angle.Double osteotomy is typically recommended for cases of hallux valgus with congruent joints and a high intermetatarsal angle (IMA).However, conventional open-or closed-wedge osteotomies are frequently ineffective, as they may not adequately correct a high IMA.We propose a novel domebased osteotomy technique for both the distal and proximal metaphysis of metatarsal bones to surgically correct HV deformity.Preoperative and postoperative assessments were conducted using the American Orthopaedic Foot & Ankle Society Metatarsophalangeal-Interphalangeal Score (AOFAS MTP-IP) score and radiological measurements, including the hallux valgus angle, intermetatarsal angle, and metatarsal articular angle.The AOFAS MTP-IP score improved from 28 preoperatively to 82 postoperatively.Radiological parameters also improved to within normal ranges.The novelty of this technique lies in the configuration of the distal metatarsal osteotomy.The primary advantage is enhanced stability due to increased contact surface area.