Abstract
BackgroundMetatarsalgia of the lesser toes is a common cause of consultation in the podiatric clinic. However, there continues to be a controversy with respect to which is the best surgical technique, and there is few information in the literature regarding objectively comparable results in percutaneous surgery.MethodsThe second metatarsal bones of 30 feet belonging to patients who had attended the podiatric clinic were studied before and after distal metatarsal pecutaneous osteotomy. The degree of shortening of the second metatarsal (RX) and the degree of functional recovery and perception of the well-being of the patient (AOFAS) were evaluated retrospectively.The same bones of 10 cadaveric feet were also studied. The surgical procedure was identical to that used on patients, and electronic callipers were employed to take measurements of the second metatarsal. The integrity of the plantar plate was checked visually.ResultsThe mean shortening of the second metatarsal bone, as determined by the radiological study, was 2.76 mm. After an average follow-up period of 1.5 years, the final mean score on the AOFAS scale was 95.26 points. In none of the cases was the mobility of the metatarsophalangeal (MTP) joint affected. The mean shortening in the cadaveric feet was 2.10 mm, and in all cases, the plantar plate and flexor apparatus were perfectly preserved.ConclusionsPercutaneous osteotomy achieved, in our study, a lower degree of shortening than Weil’s surgery, according to the data published in the literature. However, it shows good clinical results without causing problems of consolidation or rigidity in the MTP joint. Neither, with the caution that should be taken due to the use of experimental cadaver models, damage of the flexor apparatus of the foot is observed. These results suggest that this could be a safe and effective surgical procedure to be considered for metatarsalgias of the lesser rays.
Highlights
Metatarsalgia of the lesser toes is a common cause of consultation in the podiatric clinic
The objectives of this study were (1) to analyse the results of distal osteotomy of the second metatarsal bones carried out by a minimal Invasive surgery (MIS) procedure, analysing the metatarsal shortening and the patient well-being and (2) to ensure, as much as it can be done using a cadaveric model, that the plantar plate and soft tissues around the metatarsal head remain unharmed after the operation, as long as this is correctly performed
Material and methods A retrospective study was performed analysing the surgical results obtained after MIS procedure for the treatment of patients older than 18 years who attended the podiatric clinic with metatarsalgia of the central metatarsal bones which was susceptible to surgical treatment (n = 30)
Summary
Metatarsalgia of the lesser toes is a common cause of consultation in the podiatric clinic. Among problems affecting the forefoot, metatarsalgia of the lesser toes is a common cause of consultation in the podiatric clinic. It may be the outcome of numerous disorders but is most frequently associated with mechanical alterations of the forefoot, such as claw toe and insufficiency of the great toe or hallux valgus [1,2,3,4,5]. Distal osteotomies were proposed by Borggreve in 1949, by Davidson [10] in 1969, and by Weil in 1992 The latter was popularised in Europe by Barouk [11] and is nowadays one of the most frequently employed procedures. It is an osteotomy parallel to the load bearing surface of the head of the metatarsal and is fixed with screws, which allows axial decompression
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