Proximal closing wedge lesser metatarsal osteotomy for metatarsophalangeal joint transverse plane realignment. Surgical technique and outcome

Abstract

We describe the surgical technique and outcome of a proximal closing wedge osteotomy of the lesser metatarsals, to treat medial or lateral subluxation of the MTP joints, with toe deviation, when dorsiflexion (MTPJ dorsal subluxation) deformity is not present. The principle of surgical correction, is the shift of the metatarsal head in the direction of the deformity, to allow restoration of congruity of the metatarsophalangeal joint. The osteotomies were performed at the proximal metaphyseal level. At the same time, soft tissue release, consisting of division of the inter-metatarsal ligament on the other side of the deformity, allows adequate displacement. Four patients, followed for 12 months, were asymptomatic and very satisfied with the outcome, while clinical and radiographic alignment was maintained. The described surgical technique can be performed in selected patients with transverse plane deformities of the lesser metatarsals.