A, Adductor tendon released from insertion into lateral aspect of fibular sesamoid and base of proximal phalanx. B, Transverse metatarsal ligament has been transected. Inset shows that at this point, contracted lateral joint capsule, adductor hallucis, and transverse intermetatarsal ligament have been released. C, If metatarsal head springs back medially when pushed laterally, osteotomy should be considered. D, Medial capsular incision, beginning 2 to 3 mm proximal to base of proximal phalanx. Second incision is made 3 to 8 mm more proximal, removing flap of tissue. Size of flap is determined by severity of deformity. Wedge of tissue approximately 6 mm is removed. Capsular cut is V-shaped through abductor hallucis tendon with apex at tibial sesamoid. Medial eminence is exposed by making incision along dorsomedial aspect of capsule and peeling it off medial eminence with sharp dissection. E, Removal of medial eminence is done on line projected along medial aspect of the first metatarsal shaft, and exostectomy should be done 1 to 2 mm medial to sagittal sulcus. F, Knife blade is in metatarsocuneiform joint, and two lines marked on metatarsal represent osteotomy site (proximal line) and location of screw for fixation (distal line). G, Final position of screw and position of metatarsal after correction of first metatarsal. H, Note Freer elevator is displacing or rotating proximal fragment medially whereas first metatarsal head and distal fragment are being angulated laterally by manual pressure. (A-D from Mann RA, Coughlin MJ: The video textbook of foot and ankle surgery, St. Louis, 1991, Medical Video Productions; E from Mann RA, Coughlin MJ, editors: Surgery of the foot and ankle, ed 6, St. Louis, 1993, Mosby.) SEE TECHNIQUE 82.10.