A, Note valgus orientation of articular surface of first metatarsal head. B, After proximal metatarsal osteotomy on right foot. Sesamoid sling remains dislocated, articular surface of metatarsal head maintains valgus posture, and joint is congruous in valgus. Double osteotomy of first metatarsal (proximally for varus correction and distally for valgus correction of articular surface) and soft-tissue realignment are necessary. Alternatively, arthrodesis of first metatarsophalangeal joint or distal metatarsal osteotomy (chevron) can be performed. Without anatomic reduction of sesamoid sling apparatus, distal metatarsal osteotomy would fail.