Osteotomy in the treatment of metatarsalgia
Distal shortening osteotomy of the lesser metatarsals has been used successfully,
particularly in the treatment of metatarsalgia. Its advantages are a direct approach to
the metatarsophalangeal (MP) joint and the metatarsal head, providing not only correction
of the deformity, but accurate control of the metatarsal shortening, primary healing and
early functional recovery thanks to the strong fixation allowed by the twist-off screw.
Its disadvantage is the limitation of MP articular range motion, which is temporary in
The role of the osteotomy in metatarsalgia is to bring the metatarsal head
behind the callus and to provide an axial decompression resolving the hammertoe deformity
or MP luxations that are increasing or resulting in metatarsalgia. In cases of
metatarsalgia resulting from the first ray insufficiency, the osteotomy is a fair,
reliable and efficient procedure; it is also good in cases when the small metatarsal bones
are too long.
However, shortening the metatarsal bones has to be part of general forefoot
therapeutic management. In isolated metatarsalgia, the indication may be slightly
difficult, indicating a "slimming" resection. In contrast, both in important
metatarsalgia, and generally in severe forefoot disorders, the osteotomy, together with
the scarf osteotomy, constitutes a real surgical improvement, opening a new means of
articular conservative treatment of severe static disorders.
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