Outcome of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Lesser Toe Metatarsalgia

Haque, Syed; Kakwani, Rajesh; Chadwick, Carolyn; Davies, Mark B.; Blundell, Chris

doi:10.1177/1071100715598601

Cited by 60 publications

(26 citation statements)

References 25 publications

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“…Percutaneous surgery, also known as minimal Invasive surgery (MIS), is a procedure that allows the surgeon to operate through minimal incisions, without direct exposure of the surgical field, which leads to minimal trauma to the adjacent tissues and requires radiological visualization during the operation, to allow the surgeon to exert precise control over the surgical manoeuvres [12]. Percutaneous surgery cannot be considered a minor procedure simply because it is carried out through small incisions, since via these small incisions, major and even aggressive surgical techniques can be performed [13].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of results after distal metatarsal osteotomy by minimal invasive surgery for the treatment of metatarsalgia: patient and anatomical pieces study

et al. 2019

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Background Metatarsalgia of the lesser toes is a common cause of consultation in the podiatric clinic. However, there continues to be a controversy with respect to which is the best surgical technique, and there is few information in the literature regarding objectively comparable results in percutaneous surgery. Methods The second metatarsal bones of 30 feet belonging to patients who had attended the podiatric clinic were studied before and after distal metatarsal pecutaneous osteotomy. The degree of shortening of the second metatarsal (RX) and the degree of functional recovery and perception of the well-being of the patient (AOFAS) were evaluated retrospectively. The same bones of 10 cadaveric feet were also studied. The surgical procedure was identical to that used on patients, and electronic callipers were employed to take measurements of the second metatarsal. The integrity of the plantar plate was checked visually. Results The mean shortening of the second metatarsal bone, as determined by the radiological study, was 2.76 mm. After an average follow-up period of 1.5 years, the final mean score on the AOFAS scale was 95.26 points. In none of the cases was the mobility of the metatarsophalangeal (MTP) joint affected. The mean shortening in the cadaveric feet was 2.10 mm, and in all cases, the plantar plate and flexor apparatus were perfectly preserved. Conclusions Percutaneous osteotomy achieved, in our study, a lower degree of shortening than Weil’s surgery, according to the data published in the literature. However, it shows good clinical results without causing problems of consolidation or rigidity in the MTP joint. Neither, with the caution that should be taken due to the use of experimental cadaver models, damage of the flexor apparatus of the foot is observed. These results suggest that this could be a safe and effective surgical procedure to be considered for metatarsalgias of the lesser rays.

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Section: Introductionmentioning

confidence: 99%

Evaluation of results after distal metatarsal osteotomy by minimal invasive surgery for the treatment of metatarsalgia: patient and anatomical pieces study

et al. 2019

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“…However, when these conservative measures fail and the metatarsalgia becomes recalcitrant, it requires surgical treatment with or without procedures on the first ray [14, 15]. The primary goal of surgery is to relieve pain and restore an ideal forefoot morphology with a normal distribution of pressure in the forefoot [16–18]. Multiple surgical procedures have been described for this syndrome [1, 19–26].…”

Section: Introductionmentioning

confidence: 99%

Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

Biz

Corradin

Kanah

et al. 2018

BioMed Research International

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Background The purpose of this prospective study was first to evaluate the safety and effectiveness of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) in treating central metatarsalgia, identifying possible contraindications. The second objective was to verify the potential of DMMO to restore a harmonious forefoot morphotype according to Maestro criteria. Methods A consecutive series of patients with metatarsalgia was consecutively enrolled and treated by DMMO. According to Maestro criteria, preoperative planning was carried out by both clinical and radiological assessment. Patient demographic data, AOFAS scores, 17-FFI, MOXFQ, SF-36, VAS, and complications were recorded. Maestro parameters, relative morphotypes, and bone callus formation were assessed. Statistical analysis was carried out (p < 0.05). Results Ninety-three patients (93 feet) with a mean age of 62.4 (31-87) years were evaluated. At mean follow-up of 58.7 (36-96) months, all of the clinical scores improved significantly (p < 0.0001). Most of the osteotomies (76.3%) had healed by 3-month follow-up, while ideal harmonious morphotype was restored only in a few feet (3.2%). Clinical and radiological outcomes were not different based on principal demographic parameters. Long-term complications were recorded in 12 cases (12.9%). Conclusion DMMO is a safe and effective method for the treatment of metatarsalgia. Although Maestro criteria were useful to calculate the metatarsal bones to be shortened and a significant clinical improvement of all scores was achieved, the ideal harmonious morphotype was restored only in a few feet. Hence, our data show that Maestro criteria did not have a predictive value in clinical outcomes of DMMO.

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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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Outcome of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Lesser Toe Metatarsalgia

Abstract: Level IV, retrospective case series.

Cited by 60 publications

References 25 publications

Evaluation of results after distal metatarsal osteotomy by minimal invasive surgery for the treatment of metatarsalgia: patient and anatomical pieces study

Evaluation of results after distal metatarsal osteotomy by minimal invasive surgery for the treatment of metatarsalgia: patient and anatomical pieces study

Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

Cirugía por mínima incisión en los dedos menores

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