SLR - June 2020 - Robby J. Caballes

Evaluation of Results After Distal Metatarsal Osteotomy by Minimal Invasive Surgery for the Treatment of Metatarsalgia: Patient and Anatomical Pieces Study

Reference: Lopez-Vigil, M., Suarez-Garnacho, S., Martín, V., Naranjo-Ruiz, C., & Rodriguez, C. (2019). Evaluation of Results After Distal Metatarsal Osteotomy by Minimal Invasive Surgery for the Treatment of Metatarsalgia: Patient and Anatomical Pieces Study. Journal of Orthopaedic Surgery and Research, 14(1), 121. https://doi.org/10.1186/s13018-019-1159-0

Scientific Literature Review

Reviewed By: Robby J. Caballes, DPM
Residency Program: Bethesda Hospital East/West – Boynton Beach, FL

Podiatric Relevance: Metatarsalgia of the lesser rays poses a common problem of consultation in the podiatry clinic. Various surgical techniques such as the Weil osteotomy have been studied in literature with overall success and improvement in functional outcomes. However, there is sparse information in the literature regarding the results of percutaenous (minimally invasive) shortening metatarsal osteotomies. This study was designed to examine the radiographic and functional outcomes following minimally invasive shortening of the lesser metatarsals. It aims to assess the validity of its use as a reasonable alternative to open technique.

Methods: This was a dual retrospective and cadaveric study focusing on the second metatarsal of 30 patients and 10 cadaveric feet. The procedure was performed similar to an open Weil, however done percutaneously with a shannon burr. For the cadaver group, sagittal sections were made at the level of the 2nd metatarsal. Follow-up period averaged 1.5 years with in-depth analysis of AOFAS scores as well as radiographic outcomes following percutaneous minimally invasive shortening procedures.

Results: Through radiographic data, average shortening of the second metatarsal bone was 2.76 mm in the study population and 2.10 millimeters in the cadaveric study. After an average follow-up period of 1.5 years, the final average AOFAS scores improved from 50.3 to 95.26. There was no evidence of MPJ stiffness, instability, malunion, delayed union, non union, nor transfer metatarsalgia post-operatively. Successful outcomes were observed including effective shortening while preserving the plantar plate, flexor apparatus and adjacent soft tissues structures preventing common complications such as metatarsophalangeal joint instability/stiffness.

Conclusions: The authors concluded that although minimally invasive osteotomy resulted in less shortening than achieved in open surgery, that the smaller shortening is compensated likely by metatarsal head elevation and tension of unharmed soft tissues. Additionally, there is minimization of the common complications including rigidity and instability in the MPJ, while preserving the adjacent soft tissue structures. It can be further concluded from this study that although the radiographic data proved inferior to classic open technique, overall functional outcomes were still significant and improved. These findings show that minimally invasive osteotomy of the lesser metatarsals may in fact be a reasonable alternative to open technique for the right patient. This study aids in identifying the rationale for this procedure as a surgical alternative treatment option for metatarsalgia after conservative measures fail. However, limitations exist including a small sample size and need for further studies.

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