Dorsal approach to the first metatarsal

The dorsal approach to the first metatarsal is used for arthrolysis of the metatarsophalangeal joint.

It may also be employed in the fixation of first metatarsal fractures, osteotomies of the first metatarsal, 1st metatarsophalangeal arthrodesis and 1-2 intermetatarsal fusions.

The proximal part of this approach is useful for arthrodesis of the first tarsometatarsal and the 1-2 intermetatarsal joints.

Important relevant anatomical structures when approaching this part of the anatomy are the deep peroneal nerve and its branches, the dorsomedial cutaneous nerve of the hallux and the digital branch to the second toe. The approach is made between these structures.

The skin incision is made in line with the first ray, starting over the medial cuneiform and extending to the dorsolateral aspect of the first proximal phalanx.

Protect any longitudinal veins traversing the field.
In the proximal reaches of the filed, take care to dissect medial to and not damage the dorsalis pedis vessels and the cutaneous branches of the deep peroneal nerve.

Expose the first metatarsal between the tendons of extensor hallucis longus and hallucis brevis.