Midshaft Metatarsal Segmental Osteotomy With Plate Fixation

The biomechanical distribution of weight bearing and excessive load transmission through the forefoot has made the treatment of metatarsalgia challenging. In addition, structural pathology of the lesser toes and first ray mechanics often complicate the clinical evaluation and intraoperative assessment. Metatarsal shortening and elevating procedures provide an excellent treatment modality when conservative therapy options fail. Metatarsal osteotomies without internal fixation have accounted for high incidences of nonunion and pseudoarthrosis, whereas excessive bone resection causes a shift in metatarsal parabola, leading to alternative stress patterns and complications. The midshaft segmental osteotomy is a shortening procedure used for developing reliability and predictability in the treatment of metatarsalgia. Distal oblique osteotomies with single lag screw fixation are effective means to enhance stability, but can be technically demanding. The midshaft osteotomy with plate fixation is a simple procedure, with excellent union rates, preservation of metatarsophalangeal range of motion, and stable management of shortening. In its preliminary investigation, it has proved to be compliant with its overall objective to improve the predictability of metatarsal shortening and elevation, decreasing complications, and enhancing quality of life. First ray stabilization procedures, gastrocnemius recession, and hammer toe realignments may all influence outcome because metatarsalgia rarely occurs as an isolated condition.