Percutaneous distal osteotomy of lesser metatarsals for tretment of metatarsalgia

Background: Distal metatarsal osteotomy is indicated for the surgical treatment of primary metatarsalgia due to plantar hyperpressure with metatarsophalangeal instability. The aim of this prospective study was to assess the efficacy, feasibility and safety of a M.I.S. percutaneous technique for this purpose. Methods: From April 2009 to December 2011, 76 consecutive percutaneous distal osteotomies of the second, third or fourth metatarsal were performed in forty-one patients for the treatment of primary metatarsalgia with metatarsophalangeal instability. The patients were assessed with a clinical and radiographic protocol up to a mean of 39.4 (range, 24-56) months. The American Orthopaedic Foot and Ankle Society (A.O.F.A.S.) metatarsophalangeal-interphalangeal scale was used for the clinical assessment. Results: All patients reported the disappearance or reduction of the pain that they had experienced prior to the operation, in the area of the metatarsal heads. The mean total A.O.F.A.S. score improved from 39.2 (range, 9-77) points preoperatively to 93.1 (range, 44-100) points at the time of final follow-up. Union of the osteotomy site was achieved and confirmed radiographically in 39 patients out of 41 and was delayed in two cases. In two cases metatarsalgia transferred to the nearest lateral ray, in one patient there was a stress fracture of the near metatarsal. Conclusions: We consider the percutaneous distal lesser metatarsal osteotomy a reliable surgical option in metatarsalgia due to metatarsophalangeal instability in particular in early stages as in grade I and II according to Coughlin classification. The clinical results appear to be comparable with those obtainable with traditional open techniques, with the additional advantages of a minimally invasive procedure. We do not recommend this procedure for treatment of stiff dislocated metatarsophalangeal joints in grade III according to Coughlin classification