A, Metatarsal heads are dislocated plantarward and are marked; area of skin removed should be no more than 2.5 cm at widest anteroposterior diameter. B, Fourth metatarsal head is exposed, and small right-angle retractor is placed plantarward to expose neck and distal shaft. C, Articular surfaces of first metatarsophalangeal joint are shaped to allow arthrodesis in 10 to 15 degrees of valgus and 15 to 20 degrees of dorsiflexion. First ray should have been shortened more. SEE TECHNIQUE 85.3.