Here we have a patient with hypermobility of the 1st ray causing transfer metatarsalgia.

This causes pain at the other metatarsal. Also, the patient has significant equinus causing further pressure on his forefoot. The patient has failed conservative treatment.

We Started with a gastrocnemius recession as shown which helped get some range of motion in his ankle joint and reduce excessive forefoot loading.

 Next using a minimal incision technique and trephine arthrodesis we were able to fuse the 1st metatarsal cuneiform joint in the corrected position.

 The fusion site was packed with autograft from the calcaneus.

In the post-op X-rays, we can now see the 1st metatarsal in line with the second metatarsal.

The patient was allowed to be immediately weight-bearing and was in regular shoes by 6 weeks.

 Minimal scarring can be seen due to the minimal incision technique