Thomas and Smith extension osteotomy of proximal phalanx. A, Amount of bone resected from first metatarsal. Bone is resected in line with dorsal metatarsal shaft. Dorsal width of proximal phalangeal osteotomy measures 6 mm. Care is taken to protect flexor hallucis longus (FHL) tendon. B, Lateral view of metatarsophalangeal joint after proximal phalangeal dorsal closing wedge osteotomy with 3-0 wire fixation in place. (From Thomas PJ, Smith RM: Proximal phalanx osteotomy for the surgical treatment of hallux rigidus, Foot Ankle Int 20:3, 1999.) SEE TECHNIQUE 82.35.