Medial Cuneiform Transport for Segmental Defect of the First Metatarsal

Segmental deficits of the first metatarsal have been described as the result of high-energy trauma or gunshot injuries to the foot. Concomitant soft tissue injuries, extent of metatarsal bone loss, and articular involvement dictate the course of treatment. Management strategies should focus on preserving medial column length as the loss of rigid support on the medial structures has detrimental effects on foot and ankle biomechanics and may produce gait alteration and serious disability. Several reconstructive alternatives have been described for the management of these defects, including free fibular osteocutaneous graft, Masquelet technique, and second metatarsal medializing bone transportMasquelet technique and second metatarsal medializing bone transport. In the present case report, we present a patient with a 3 centimeters bone defect of the first metatarsal diaphysis after sustaining a gunshot injury to his left foot. We describe a novel technique for reconstruction of the first metatarsal, consisting of anterograde transport of the medial cuneiform associated with arthrodesis of the first tarsometatarsal joint.