A, Metatarsophalangeal joint is exposed through dorsal approach. B, Distal 3 to 5 mm of metatarsal head is removed with sagittal saw. C, Base of proximal phalanx is removed. D, Incisions for excisional arthroplasty. E, Lesser metatarsophalangeal joints are approached through dorsal incisions in second and fourth web spaces. F, Diagram showing resection of metatarsal heads. G, After fusion site has been stabilized with Kirschner wires, interfragmentary screw is inserted if bone stock is strong enough. H, Fixation of arthrodesis site with six-hole, one-quarter tubular AO plate. I, Pinning of arthrodesis site with ⅛-inch threaded Steinmann pins. SEE TECHNIQUE 85.1.