PMC8500382_01
(A) HVA (hallux valgus angle); (B) IMA (intermetatarsal angle); (C) PFMI (proximal first metatarsal inclination angle).
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Radiographic evaluation included assessment of hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), proximal first metatarsal inclination angle (PFMI), and radiographic union (Figure 3). Both hallux valgus angle and 1-2 intermetatarsal angle have shown high intraobserver and interobserver reliability across multiple studies.   PFMI was selected as a measure of first TMT joint obliquity.   PFMI was measured as the angle between a line perpendicular to the axis of the second metatarsal and a line parallel to the proximal articular surface of the first metatarsal, which is easier to visualize than the articular surface of the medial cuneiform (Figure 3C).
(A) The dashed line represents the planned osteotomy that is made parallel to the metatarsocuneiform joint and extends across three-fourths of the width of the cuneiform. (B) A postfixation image is recommended to verify the reduction of the metatarsophalangeal joint and the sesamoids.
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An osteotomy was made parallel to the TMT joint through approximately three-fourths of the width of the bone (Figure 4A). A final fluoroscopic examination was performed confirming reduction of the hallux metatarsophalangeal joint, sesamoid position, and osteotomy fixation (Figure 4B).