The medial approach to the first metatarsal is used for the fixation of certain fractures of the first metatarsal, for osteotomies of the first metatarsal, or for transfer of the flexor hallucis longus tendon into the base of the first metatarsal.
In the adult, the first metatarsal is supplied by an artery entering the first metatarsal head via the plantar distal metaphysis.
The courses of the dorsomedial collateral nerve (usually the superficial peroneal nerve), and the medial plantar hallucial nerve are as illustrated. The abductor hallucis tendon inserts into the medial capsule of the first metatarsophalangeal (MTP) joint.
3. Skin incision
The skin is incised over the medial aspect of the metatarsal shaft, starting at the medial cuneiform and extending distally to the first metatarsophalangeal joint .
4. Exposure of the bone
Find the dorsal edge margin of the abductor hallucis muscle and retract it plantarwards.
Free the distal part of the tibialis anterior tendon to gain access to the first cuneometatarsal joint.