Percutaneous dorsal closing wedge osteotomy of the metatarsal neck in management of metatarsalgia

• Metatarsalgia can be caused by plantarflexion of a central metatarsal or discrepancies in the metatarsal length.
• For those recalcitrant cases, metatarsal osteotomy is needed to relieve the pain.
• Percutaneous dorsal closing wedge osteotomy of the metatarsal neck is effective and safe.

IntroductionMetatarsalgia can be caused by plantarflexion of a central metatarsal or discrepancies in the metatarsals’ length. Nonsurgical management is usually sufficient to achieve satisfactory results. For those recalcitrant cases, metatarsal osteotomy is needed to relieve the pain. We describe a technique of percutaneous dorsal closing wedge osteotomy of the metatarsal to manage the recalcitrant metatarsalgia. A case series was reviewed retrospectively.Materials and methodsFrom March 2010 to March 2013, percutaneous dorsal closing wedge osteotomy of the metatarsal neck has been performed in 33 patients. Thirty six feet with 63 metatarsals were operated on. Thirty two second metatarsals, 22 third metatarsals, 5 fourth metatarsals and 4 fifth metatarsals were operated on.ResultsAll the osteotomy sites healed up without any transverse plane deformity. The painful callosities subsided except in one operated metatarsal. Recurrence of painful callosities occurred in 2 operated metatarsals. Transfer metatarsalgia occurred in 2 feet. Floating toe deformity occurred in 2 operated rays. There was no nerve injury noted. Two patients had delayed wound healing with serous discharge and the wounds were eventually healed up with wound dressing.ConclusionPercutaneous dorsal closing wedge osteotomy of the metatarsal neck is an effective and safe surgical treatment of recalcitrant metatarsalgia.