The Journal of Bone and Joint Surgery (American). 2007;89:2018-2022.
doi:10.2106/JBJS.F.01030
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Blood Supply to the First Metatarsal Head and Vessels at Risk with a Chevron Osteotomy

J.J. George Malal, MBBS, DOrtho, MS(Ortho), DNB(Ortho), MRCS1, J. Shaw-Dunn, BSc, MBChB, PhD, FRCS, AIAS2 and C. Senthil Kumar, FRCS(Tr&Orth)3

1 MRCS 36 Nazareth House Lane, Widnes, Cheshire WA8 8UE, United Kingdom. E-mail address: drjobyjacob{at}rediffmail.com
2 Department of Human Anatomy, University of Glasgow, Glasgow G12 8QQ, United Kingdom
3 Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom

Investigation performed at the Department of Human Anatomy, University of Glasgow, Glasgow, United Kingdom

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Chevron osteotomy, a commonly performed procedure for the treatment of hallux valgus, results in osteonecrosis of the first metatarsal head in 0% to 20% of cases. The aim of this study was to map out the arrangement of the vascular supply to the first metatarsal head and its relationship to the limbs of the chevron osteotomy.

Methods: Ten cadaveric lower limbs were injected with an India ink-latex mixture, and the feet were dissected to assess the blood supply to the first metatarsal head. The dissection was carried out by tracing the branches of the dorsalis pedis and posterior tibial vessels. A distal chevron osteotomy was mapped, with the limbs of the osteotomy set at an angle of 60° from the geometric center of the first metatarsal head. The relationship of the limbs of the osteotomy to the blood vessels was recorded.

Results: The first metatarsal head was found to be supplied by branches from the first dorsal metatarsal, first plantar metatarsal, and medial plantar arteries. The first dorsal metatarsal artery was the dominant vessel among the three arteries in eight specimens. All of the vessels formed a plexus at the plantar-lateral aspect of the metatarsal neck, just proximal to the capsular attachment, with a varying number of branches from the plexus then entering the metatarsal head. The plantar limb of the proposed chevron cuts exited through this plexus of vessels in all specimens. Contrary to the widely held view, only minor vascular branches could be found entering the dorsal aspect of the neck.

Conclusions: The identification of the plantar-lateral corner of the metatarsal neck as the major site of vascular ingress into the first metatarsal head suggests that constructing the chevron osteotomy with a long plantar limb exiting well proximal to the capsular attachment may decrease the postoperative prevalence of osteonecrosis of the first metatarsal head.


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