Surgical strategies: Ludloff first metatarsal osteotomy.

Moderate to severe hallux valgus deformities associated with a wide first intermetatarsal angle require a first metatarsal osteotomy for adequate correction. A variety of procedures have been introduced such as the crescentic, chevron, scarf, closing or opening wedge osteotomies of the first metatarsal base, and the Ludloff and Mau procedures.7,8,10,15,16,17,24,27 Recently the Ludloff osteotomy has risen in popularity as demonstrated in clinical and biomechanical publications.1,2,3,5,6,11,13,22,26 The Ludloff first metatarsal osteotomy was described in 1918 by Ludloff.14 Indications for the procedure were substantial metatarsus primus varus and hallux valgus deformities. As originally described, the Ludloff procedure was designed as a long oblique osteotomy from dorsal proximal to plantar distal that allowed realignment and shortening of the first metatarsal. A distinctive advantage of the geometry of the Ludloff osteotomy is that the relatively large proximal bone fragment allows secure fixation. Although Ludloff claimed excellent results, the original technique before the advent of rigid screw fixation had complications such as delayed union, nonunion, and malunion.