Avascular necrosis of the first metatarsal head.

Avascular necrosis of the first metatarsal head is uncommon. It is most often seen following a distal metatarsal osteotomy for hallux valgus. In this setting surgery has usually involved extensive periarticular dissection as well. Although many cases may be subclinical, in its most pronounced form it is a powerful cause of failure of bunion surgery. This article examines the underlying factor contributing to this problem as well as its long-term management.