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

Abstract

Background and aims: Surgical procedures for central metatarsalgia seek to harmonise the metatarsal parabola with osteotomies that can be performed by minimally invasive techniques. However, the possible relationship of the foot type and the mid-term postoperative outcome is poorly described. The objective of this prospective pilot study was therefore to determine whether the foot type (pronate, neutral, or supinate) conditions the postoperative mid-term functional outcome.Methods: A series of 28 patients (6 men, 22 women) were treated for primary central metatarsalgia by means of minimally invasive distal metaphyseal osteotomy (DMMO).Results: Their functional outcomes at 6 and 12 months were assessed by the self-reporting AOFAS scale. Pre-surgery, the patients' scores were 42.82 ± 15.60. Scores improved at 6 months to 86.50 ± 8.6 and to 92.93 ± 8.6 at 12 months (p < 0.001 in both cases). There were no differences either by sex or by foot type in these overall values, although there was only a slight limitation of interphalangeal mobility in the supinated feet (p = 0.03) at 6-month follow-up as compared to other foot types.Conclusion: Hence, DMMO provides an optimal clinical and functional outcome for the surgical treatment of metatarsalgia, regardless of the patient's foot posture. The occurrence of adverse events was minimal and clinically irrelevant.Trial registration: The study was authorised by the Research Ethics Committee of the Universidad Católica de Valencia San Vicente Mártir, with the registry UCV/2018-2019/019.

Comparative analysis of bone consolidation chronology in claw toes operated through minimal invasive osteotomies in diabetic vs. non-diabetic patients

“…Recently, foot minimally invasive surgery has gained popularity in DM patients ( 40 , 41 ). The scarcity of scarring or tissue damage, the low number of complications ( 33 , 42 ) as well as the absence of osteosynthesis reduce the number of infections while could favor the recovery time ( 13 , 43 ). Several studies have pointed out that, given the existence of these techniques (i.e., minimally invasive), surgical interventions in diabetic patients should not be extended to the threat of loss of parts or tissues, since they could be used preventively ( 13 , 44 ).…”

“…In this regard, percutaneous techniques require delicate management of the dressing. Previous studies have shown that the meticulousness of the dressing benefits the correct alignment of the fingers in the absence of osteosynthesis ( 33 , 42 ). The compression of these bandages and their traction favor the formation of bone and fibrous tissue based on Roux's Law, which relates bone remodeling to the adaptive process of cells influenced by local stresses in the area.…”

Improving the Accuracy of Metatarsal Osteotomies in Minimally Invasive Foot Surgery Using a Digital Inclinometer: Preliminary Study

“…Positioned at a 90-degree angle to the skin surface above the affected metatarsal head, the surgeon aligns parallel to the extensor muscle of the toe. A 2 mm incision is meticulously made using a Beaver 64 scalpel blade, penetrating through the joint capsule to access the underlying bone [21].…”

“…Specifically, in the context of minimal incision foot surgery, conventional practices often rely on the visual acumen of surgeons coupled with fluoroscopic assessments [15][16][17][18] to execute freehand osteotomies. Nevertheless, a recurrent challenge encountered in these minimal incision surgeries persists: the necessity to perform osteotomies at a specific angle of 45 • [18][19][20][21]. This particular requirement poses a considerable hurdle, demanding a high degree of precision and skill from the surgical team.…”

Muscle strength and foot pressure vary depending on the type of foot pain

“…In middle-aged and older women, the most common cause of foot pain is plantar fasciitis 4 , followed by metatarsalgia 5 . Plantar fasciitis is commonly observed in flat feet and often causes pain in the heel owing to excessive stretching of the plantar fascia 6 , 7 .…”