Metatarsal Osteotomy for Metatarsalgia

Helal, Basil

doi:10.1302/0301-620x.57b2.187

Cited by 171 publications

(76 citation statements)

References 3 publications

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“…Furthermore this is a very aggressive technique for the management of isolated metatarsalgia, hence, it can be used only in patients with severe symptoms. In 1975, Helal described an oblique metatarsal osteotomy of the metatarsal neck [8]. Nevertheless this technique gives transfer metatarsalgia and non-union, as showed by Trnka et al [1].…”

Section: Discussionmentioning

confidence: 99%

“…The Weil osteotomy achieves good results with success rates between 65% and 88% and for this reason it remains the gold standard in the treatment for metatarsalgia. The complication rate of delayed union and non union is very low [8], however this technique may give floating toe deformity, stiffness and loss of motion of the metatarso-phalangeal joint in about 40% of patients, or problems related to the internal fixation (3%-29%) [1,10]. Therefore, distal metatarsal osteotomy should be performed when the metatarso-phalangeal joint is impaired.…”

Section: Discussionmentioning

confidence: 99%

“…However, the bone healed correctly only in 24% of patient [10]. In general, proximal osteotomies are more difficult from a technical point of view, and the long lever arm between the osteotomy site and the metatarsal head makes the final position less predictable than distal osteotomies [8,10]. Complications following metatarsal osteotomy include transfer metatarsalgia, painful bone callus, recurrence, stiffness and/or instability of the metatarso-phalangeal joint, malalignment and nonunion or delayed unions [8,[10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…Fixation is a controversial topic. Many authors suggest that fixation is not necessary because the weight bearing may bring the metatarsal segment in the correct position [8,[11][12][13].…”

Section: Discussionmentioning

confidence: 99%

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Does Proximal Metatarsal Osteotomy Need Internal Fixation? A Case Report

N¹,

L²,

Bonifacini³

et al. 2015

Clin Res Foot Ankle

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Internal fixation for proximal metatarsal osteotomies is generally not required, since many authors state that weight bearing may promote fusion of the metatarsal segments in the correct position.This study reports a case of a 54 years old woman affected by metatarsalgia who was treated surgically with a proximal metatarsal osteotomy. Radiographies showed a non-union of the metatarsal osteotomy and MRI, bone scintigraphy and blood tests excluded infection. Surgical treatment consisted in debridement of fibrous non-union, autologous bone grafting and plate and screw fixation. The plate was removed 12 months after the surgery because of soft tissue irritation and hardware prominence.At the last follow-up, the patient was pain free and resumed her daily activities.In general, proximal osteotomies are safe procedures for the treatment of metatarsalgia. Although fixation is a controversial topic, it should be reconsidered in order to avoid nonunion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Fixation is a controversial topic. Many authors suggest that fixation is not necessary because the weight bearing may bring the metatarsal segment in the correct position [8,[11][12][13].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Does Proximal Metatarsal Osteotomy Need Internal Fixation? A Case Report

N¹,

L²,

Bonifacini³

et al. 2015

Clin Res Foot Ankle

View full text Add to dashboard Cite

show abstract

“…Resection arthroplasties of the metatarsal heads have been described, including partial metatarsal head resection, resection of the base of the proximal phalanx or combined metatarsal head and proximal phalanx resection. Over time deterioration of results have been reported including recurrences and lost function [5][6][7]. As alternative methods metatarsal shortening osteotomies have been described for the metatarsal neck or midshaft.…”

Section: Introductionmentioning

confidence: 99%

The Weil osteotomy for correction of the severe rheumatoid forefoot

Trieb

Hofstaetter

Panotopoulos

et al. 2013

International Orthopaedics (SICOT)

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Purpose In rheumatoid arthritis the metatarsophalangeal (MTP) joints are predominantly affected with resultant metatarsalgia and dislocation. Therapy options include many different surgical procedures with results that are not always satisfying. We present the oblique Weil metatarsal osteotomy as a treatment option for the rheumatic forefoot. Methods A total of 216 osteotomies in 63 consecutive patients (72 feet) with a mean age at the time of surgery of 59.3 years and long-standing rheumatoid arthritis were observed prospectively for an average of 57.4 months (minimum 36 months). All patients received a Weil osteotomy of the lesser metatarsals with at least one additional procedure of the forefoot. Patients were evaluated prospectively for clinical outcome by the American Orthopaedic Foot and Ankle Society (AOFAS) lesser MTP-interphalangeal scale and subjective satisfaction. In the radiological evaluation weight-bearing X-rays were analysed for alignment, shortening and union. Results American Orthopaedic Foot and Ankle Society score increased significantly from 21.9±6.7 to 63.3±9.8 (p<0.05). The increase was significant for all subgroups regarding pain, function and alignment. All joints were dorsally dislocated preoperatively; a subluxation was present in 13.6 % at follow-up. There was a significant decrease of callositas in 82 %, a decrease in need for orthopaedic shoes in 61 %, a decrease of MTP joint stiffness in 96 % and a relief of severe pain in 97 % of all patients. No metatarsal head dislocation or necrosis, pseudoarthrosis or screw perforation was observed. Of 63 patients, 55 (88 %) subjectively reported excellent or good results. Conclusions We conclude that the Weil procedure for lesser metatarsals is a satisfactory method for correcting the rheumatic forefoot and can be recommended as an approach for the future.

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Second metatarsal osteotomies for metatarsalgia: A robotic cadaveric study of the effect of osteotomy plane and metatarsal shortening on plantar pressure

et al. 2013

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Symptom relief of recalcitrant metatarsalgia can be achieved through surgical shortening of the affected metatarsal, thus decreasing plantar pressure. Theoretically an oblique metatarsal osteotomy can be oriented distal to proximal (DP) or proximal to distal (PD). We characterized the relationship between the amount of second metatarsal shortening, osteotomy plane, and plantar pressure. We hypothesized that the PD osteotomy is more effective in reducing metatarsal peak pressure and pressure time integral. We performed eight DP and eight PD second metatarsal osteotomies on eight pairs of cadaveric feet. A custom designed robotic gait simulator (RGS) generated dynamic in vitro simulations of gait. Second metatarsals were incrementally shortened, with three trials for each length. We calculated regression lines for peak pressure and pressure time integral vs. metatarsal shortening. Shortening the second metatarsal using either osteotomy significantly affected the metatarsal peak pressure and pressure time integral (first and third metatarsal increased, p < 0.01 and <0.05; second metatarsal decreased, p < 0.01). Changes in peak pressure (p ¼ 0.0019) and pressure time integral (p ¼ 0.0046) were more sensitive to second metatarsal shortening with the PD osteotomy than the DP osteotomy. The PD osteotomy plane reduces plantar pressure more effectively than the DP osteotomy plane. Keywords: second metatarsal; plantar pressure; metatarsalgia; lesser metatarsal osteotomies; gait simulation Metatarsalgia is defined as pain, often during weight bearing, of the plantar aspect of the foot under and related to the lesser metatarsal heads. Primary metatarsalgia is associated with biomechanical insufficiencies, and secondary metatarsalgia is associated with systemic conditions. 1 Initially, metatarsalgia is managed with rest, stretching exercises, cushioning, plantar callosity shaving, and anti-inflammatory medications, but data confirming their effectiveness is limited.2 If symptoms persist, surgery is employed to correct the alignment of the metatarsals and/or muscle/ligament balance. Numerous surgical treatments are used, each with its benefits and complications.2-6 Surgical treatment redistributes pressure under the metatarsal heads 7 by either dorsally displacing the head or by shortening the length of the metatarsal. 3 The amount of shortening is determined by the surgeon's experience considering the preoperative length of the metatarsals. 4,8 In this study, we compared the effects of two different osteotomy planes and the overall amount of second metatarsal shortening on plantar pressure. Insight into the relationship between osteotomy plane, metatarsal shortening, and plantar pressure contributes to a more effective treatment of metatarsalgia by providing the surgeon with greater knowledge of biomechanical principles that can be used to make intraoperative osteotomy decisions.The oblique distal to proximal (DP) sliding osteotomy and the oblique proximal to distal (PD) sliding osteotomy are designed to reduce sec...

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Metatarsal Osteotomy for Metatarsalgia

Abstract: Oblique osteotomy through the distal half of the shaft of the metatarsal. It is essential that the distal fragment should slide up on the proximal fragment and not angulate.

Cited by 171 publications

References 3 publications

Does Proximal Metatarsal Osteotomy Need Internal Fixation? A Case Report

Does Proximal Metatarsal Osteotomy Need Internal Fixation? A Case Report

The Weil osteotomy for correction of the severe rheumatoid forefoot

Second metatarsal osteotomies for metatarsalgia: A robotic cadaveric study of the effect of osteotomy plane and metatarsal shortening on plantar pressure

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