Which condition would most likely require a dorsiflexion osteotomy of the first ray?

• A. Forefoot-driven cavus
• B. Rearfoot-driven cavus
• C. Calcaneal varus
• D. Ankle arthritis

Answer: (A)

When the deformity is driven by the forefoot, specifically a plantarflexed first ray that creates forefoot cavus and metatarsus primus elevatus, the goal is to address that forefoot position directly. A dorsiflexion osteotomy of the first ray raises the first metatarsal into a more neutral alignment relative to the hindfoot. This reduces the abnormal height of the medial column, decreases pressure under the first ray, and flattens the cavus deformity from the forefoot side. It’s a targeted solution for forefoot-driven cavus because it corrects the component of the deformity located at the forefoot.

If the cavus were rearfoot-driven—for example, due to hindfoot varus—the appropriate correction would come from hindfoot procedures, not a first-ray osteotomy, and ankle arthritis represents a joint pathology outside the forefoot correction.