Minimally Invasive Distal Metatarsal Osteotomy in the Treatment of Primary Metatarsalgia

Abstract

Introduction: Metatarsalgia is a common presentation to orthopaedic surgeons. Primary metatarsalgia is caused by chronic imbalance in weight-bearing distribution across the forefoot or between the forefoot and midfoot. Management of primary matatarsalgia is mainly conservative. Metatarsal osteotomy can be considered if conservative treatment has failed. Minimally Invasive Distal Metatarsal Osteotomy technique can achieve satisfactory outcomes. Method and material: From April 2009 to May 2010, we performed distal metatarsal osteotomies using minimally invasive technique in four patients (3 females and 1 male). Stab incision was made, and metatarsal neck osteotomy was achieved with a burr. No internal fixation was performed. Full weight bearing walking was allowed on the first day after operation. Radiographs were taken before and after operations, and forefoot scores were documented by using the American College of Foot and Ankle Surgeons score. Result: The average age of the four patients was 55.8 years (range 46–62). The average operation time was 40 minutes (range 24–65). Blood loss was minimal in all patients. The length of hospital stay was 4 days in all patients. All osteotomies healed uneventfully in 4 months. There was no major complication. The average metatarsal index decreased from 3.125 to 2.8 mm, and the average first/second inter-metatarsal angle on lateral X-ray decreased from 6° to 2°. The average American College of Foot and Ankle Surgeons score improved from 66.25 (range 56–74) preoperatively to 96.25 (range 93–99) postoperatively. Conclusion: Minimally Invasive Distal Metatarsal Osteotomy without internal fixation is a viable alternative to open procedure in the management of recalcitrant metatarsalgia.

Keywords

• distal metatarsal osteotomy
• metatarsalgia
• minimally invasive