Evaluation of results after distal metatarsal osteotomy by minimal invasive surgery for the treatment of metatarsalgia: patient and anatomical pieces study

Abstract

Background Metatarsalgia 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. Methods The 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. Results The 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. Conclusions Percutaneous 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.

Influence of Foot Type on the Clinical Outcome of Minimally Invasive Surgery for Metatarsalgia. A Prospective Pilot Study

“…Our study's values were similar to those reported by López-Vigil ( 24 ) who, with similar minimally invasive techniques, were able to improve the clinical status from 50.3 points pre-operatively to 95.2 points at an average of 18 months after surgery. Both the present study and that by López-Vigil ( 25 ) reached higher post-operative scores than those for the DMMO technique reported by ( 27 ) with 88 points at 6 months, ( 24 ) with 84.1 at 58.7 months on average, and ( 26 ) with 86.5 points at 14 months after surgery.…”

“…This may be related to the choice of the point at which to perform the osteotomy, as it was done intracapsularly. This does not damage the plantar plate ( 25 ), and the reduced need for recovery of the soft tissues surrounding the joint could be related to the absence of post-operative stiffness at 6 and 12 months.…”

“…There are variations in the way of performing DMMO osteotomies. In this study, we used the intracapsular osteotomy, as in the López-Vigil study ( 25 ).…”

“…The patients were asked to visit the centre where the procedure had been performed for AOFAS scale measurements at 6 months and at 12 months post-intervention. These periods represent normalisation of gait after the disappearance of residual œdema and any type of pain related to the intervention ( 25 , 34 ).…”

“…For example, ( 26 , 27 ) achieved post-operative AOFAS scale scores of 86.5 and 88 with DMMO, as against 85.3 and 86, respectively, obtained with Weil's osteotomy. Indeed, AOFAS scores of up to 95.26 points have been achieved with DMMO ( 25 ). Similarly, studies that used another scale–the Manchester-Oxford Foot Questionnaire–have also reported acceptable ( 28 ) or good ( 29 ) improvements, with outcomes reaching a score of 31 (the lower the score, the better the outcome) in isolated metatarsal surgery ( 5 ).…”