Minimally Invasive Distal Metatarsal Osteotomy in the Treatment of Primary Metatarsalgia

IntroductionMetatarsalgia is a common presentation to orthopaedic surgeons. Primary metatarsalgia is caused by chronic imbalance in weight-bearing distribution across the forefoot or between the forefoot and midfoot. Management of primary matatarsalgia is mainly conservative. Metatarsal osteotomy can be considered if conservative treatment has failed. Minimally Invasive Distal Metatarsal Osteotomy technique can achieve satisfactory outcomes.Method and materialFrom April 2009 to May 2010, we performed distal metatarsal osteotomies using minimally invasive technique in four patients (3 females and 1 male). Stab incision was made, and metatarsal neck osteotomy was achieved with a burr. No internal fixation was performed. Full weight bearing walking was allowed on the first day after operation. Radiographs were taken before and after operations, and forefoot scores were documented by using the American College of Foot and Ankle Surgeons score.ResultThe average age of the four patients was 55.8 years (range 46–62). The average operation time was 40 minutes (range 24–65). Blood loss was minimal in all patients. The length of hospital stay was 4 days in all patients. All osteotomies healed uneventfully in 4 months. There was no major complication. The average metatarsal index decreased from 3.125 to 2.8 mm, and the average first/second inter-metatarsal angle on lateral X-ray decreased from 6° to 2°. The average American College of Foot and Ankle Surgeons score improved from 66.25 (range 56–74) preoperatively to 96.25 (range 93–99) postoperatively.ConclusionMinimally Invasive Distal Metatarsal Osteotomy without internal fixation is a viable alternative to open procedure in the management of recalcitrant metatarsalgia.

中文摘要蹠骨痛症是一種骨科醫師經常遇到的表徵。原發性蹠骨痛症起因是前足或前足和中足之間的慢性負重分配不平均。原發性蹠骨痛症主要是以保守方法治療。如果保守治療失效，可以考慮蹠骨截骨術。遠端蹠骨微創截骨術（MIDMO）可以取得令人滿意的效果。方法和材料：從 2009年4月至2010年5月間，我們為四病人（3女1男）進行遠端蹠骨微創截骨術。利用一枚,鑽孔器經過微創切口完成，並沒有進行內固定術。手術後的第一天允許完全負重行走。手術前後分別拍X光片，並使用美國足部外科醫生學會指數(ACFAS) 紀錄得分。結果：4例患者的平均年齡為55.8歲（由46至62），平均手術時間為40分鐘（由24至65）。所有患者的失血量極小。所有患者的住院時間均為四天。所有截骨於術後四個月順利地癒合，並且沒有重大的併發症。術後的平均蹠骨指數從3.125毫米降至2.8毫米，從X光侧面量度1st/2nd平均蹠骨間角從6度降至2度。平均ACFAS得分從術前66.25（由56至74）改善至手術後96.25（由93至99）。結論：無內固定的遠端蹠骨微創截骨術 (MIDMO)是開放性手術以外，於頑固蹠骨痛症的一個可行治療方法。