Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Learning Curve

Krenn, Sabine; Albers, Sascha; Böck, Peter; Mansfield, Clemens; Chraim, Michel; Trnka, Hans-Joerg

doi:10.1177/1938640017750251

Cited by 22 publications

(19 citation statements)

References 18 publications

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“…Otros autores 28,29 , teniendo en referencia la escala visual analógica del dolor (VAS), encuentran mejores valores en la cirugía percutánea (2,5) respecto a la cirugía abierta (3,5). También publican, en cuanto a las complicaciones producidas por infección postquirúrgica en cirugía digital, mejores valores para la cirugía percutánea: en una muestra de 675 dedos intervenidos describen una incidencia de infecciones de 2,2 % en percutánea y del 5,3 % en abierta.…”

Section: Discussionunclassified

Cirugía por mínima incisión en los dedos menores

Freixas¹,

Sánchez²

2019

Rev. Esp. Pod.

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Keywords:Minimally invasive surgery, lesser (and greater) toe percutaneous surgery, lesser (and greater) toe surgery, hammer toe, claw toe, lesser toe deformity, MIS, phalanges of the lesser toes. Palabras clave:Cirugía por mínima incisión, cirugía percutánea digital, cirugía digital, dedo en martillo, dedo en garra, deformidad digital, MIS, falanges digitales. ResumenCon este trabajo se pretende dar una actualización y opinión sobre los diferentes procedimientos en cirugía MIS para la corrección de la patología digital mediante la descripción e indicación de las diferentes técnicas, así como la evolución de las mismas. Las técnicas originales en cirugía MIS para la corrección de la patología digital fueron las osteotomías completas; a continuación se adaptaron de la cirugía a campo abierto la artroplastia y la artrodesis por MIS, para más tarde desarrollar las osteotomías incompletas, en las que una parte de la cortical ósea se deja intacta. En sus inicios era indispensable la cirugía sobre tejidos blandos, tenotomías y capsulectomías como parte de la cirugía digital. Hoy en día en las actuaciones digitales, según el grado de deformidad y edad del paciente, se intenta evitar la cirugía sobre tejido blando y corregir la deformidad mediante la actuación en tejido óseo para evitar la deficiencia de movilidad postoperatoria que se produce al realizar tenotomías. AbstractThis study aims to update the various minimally invasive procedures when surgically restoring the normal alignment of the lesser toes and also provides the opinion of the author. This is done through the description and indication of the different MIS techniques and their evolution over time. The first lesser toe MIS procedures were initially performed in a complete osteotomy treatment. Over the years, this alternative was expanded into arthroplasties and arthrodesis surgeries, both commonly used as open methods and finally the minimally invasive correction was practised on partial osteotomies where a portion of the cortical is retained. In the past, lesser toe surgery procedures always involved soft tissue damage, tenotomies and capsular release. Nowadays, based on the type of the deformity and patient age, soft tissue work is avoided and the corrective surgery is preferably done through bone structure treatment strategies instead. This option is carried out to minimise the longer recovery time and mobility impairment associated with tenotomies.

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Section: Discussionunclassified

Cirugía por mínima incisión en los dedos menores

Freixas¹,

Sánchez²

2019

Rev. Esp. Pod.

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“…The skin incision is placed dorsomedial or dorsolateral (depending on the surgeons' dominant hand) of the affected MTP joint under image converter control (Figure 1A). 24 Soft tissue release is carried out under constant bone contact from extensor to flexor tendons using a clamp and freer elevator (Figure 1B). The minimally invasive low-speed high-torque burr (Wright Medical) is placed at the level of the epi-metaphyseal border at 45 degrees relative to the metatarsal axis (Figure 2).…”

Section: Operative Proceduresmentioning

confidence: 99%

“…The minimally invasive low-speed high-torque burr (Wright Medical) is placed at the level of the epi-metaphyseal border at 45 degrees relative to the metatarsal axis (Figure 2). 18,24,43 Subsequently, an extracapsular osteotomy is performed in a circular motion from plantar proximal to dorsal distal, cutting the medial/lateral cortex first, followed by the plantar, lateral/medial, and dorsal cortices (Figure 1C). 10,18 After successful mobilization of the MTH, no osteosynthesis is needed.…”

Section: Operative Proceduresmentioning

confidence: 99%

“…10 In comparison with the open technique, this method has the advantage of minimal injury to the adjacent tissues, less scarring, a shorter operative time, as well as shorter hospitalization. 10,18,24,25,43,50 To date, the percutaneous osteotomy has already proven to be a valid technique by achieving satisfactory clinical and radiologic results in the treatment of metatarsalgia. 6,10,24,25,32,42,43 We analyzed the results of the DMMO after an average follow-up time of 15.5 months (minimum 11, maximum 25 months).…”

Section: Introductionmentioning

confidence: 99%

“…10,18,24,25,43,50 To date, the percutaneous osteotomy has already proven to be a valid technique by achieving satisfactory clinical and radiologic results in the treatment of metatarsalgia. 6,10,24,25,32,42,43 We analyzed the results of the DMMO after an average follow-up time of 15.5 months (minimum 11, maximum 25 months). The objectives of this study were (1) to appraise the clinical outcome including the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, the Foot and Ankle Outcome Score (FAOS), and Foot Function Index (FFI); (2) to assess the pain pre-and postoperatively, using a visual analog scale; (3) to determine the radiologic outcome by measuring the Maestro Index, the total length reduction of the metatarsal bones and to evaluate the bone consolidation after the osteotomy; (4) to analyze pre-and postoperative pedobarographic measurements and their changes.…”

Section: Introductionmentioning

confidence: 99%

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

Neunteufel¹,

Krenn

Chraim³

et al. 2021

Foot Ankle Int.

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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.

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