Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes

Abstract

Background: The minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) is a percutaneous operative technique with the aim to relieve the symptoms of metatarsalgia. To our knowledge, no previous research has analyzed both pre- and postoperative pedobarographic data including the changes in plantar pressure. Methods: Thirty patients (31 feet) were operated on with a DMMO and included in a prospective study. Clinical, radiologic, and pedobarographic outcomes were evaluated in comparison with the preoperative parameters. The American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, the Foot Function Index (FFI), the Foot and Ankle Outcome Score (FAOS), and a visual analog scale (VAS) for pain were used in order to assess clinical parameters. Radiographs were taken to compare metatarsal lengths. The pedobarographic analysis served to determine plantar peak pressure (PPP) beneath the metatarsophalangeal (MTP) joints. Results: All scores indicated a significant mean pre- to postoperative improvement (AOFAS = 31.9 points, FAOS = 16.3%, FFI = 24.3%, VAS pain = 4.1 points, VAS general limitation = 3.3 points) ( P < .05). PPP was substantially reduced in the relevant area (M6 [plantar area beneath the second and third MTP joint] had a mean pre to post PPP = 14.15 N/cm2) and concurrently higher in the lateral and medial MTP joint areas (M5 mean pre to post = +14.37, M7 pre to post = +7.11). Our mean metatarsal shortening was 6.6 mm. However, our findings do not demonstrate a significant correlation between metatarsal length relationships and the prevalence of metatarsalgia. Conclusion: Our results demonstrate a significant improvement in clinical scores and PPP. A statistically significant relation between metatarsal length and the prevalence of metatarsalgia was not found in this prospective case series Level of Evidence: Level IV, case series.

What’s New in Foot and Ankle Surgery

“…Minimally invasive techniques involving the lesser metatarsals continue to grow in popularity. Neunteufel et al 1 reported a case series of 30 patients (31 feet) who underwent minimally invasive distal metatarsal metaphyseal osteotomy for metatarsalgia of ≥1 lesser metarsals 2-5 . All clinical scores (American Orthopaedic Foot & Ankle Society [AOFAS] Forefoot Score, Foot Function Index, Foot and Ankle Outcome Score [FAOS], and visual analog scale [VAS] pain score) improved significantly at a mean follow-up of 15.5 months.…”

“…Walter C. Hembree, MD1 Mitchell C. Tarka, MD1 Jordan B. Pasternack, MD 1 Smitha E. Mathew, MBBS1 Gregory P. Guyton, MD1 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland Email for corresponding author: gpguyton@gmail.com…”

Foot & Ankle

“…We were delighted to see this paper from Vienna (Austria) , where the team objectively reviewed and reported the results of their prospective series to enrich us with a suitable piece of objective evidence. 1 Patients with metatarsalgia of the lesser rays who failed conservative therapy for over a year were offered DMMO. Those with subluxation of one of the lesser metatarsophalangeal (MTP) joints, peripheral vascular disease, inflammatory arthropathy, and peripheral neuropathy (including metatarsalgia associated with Charcot arthropathy) were excluded from the report.…”