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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2021, Number 5

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Acta Ortop Mex 2021; 35 (5)

Clinical results of treatment of mechanical metatarsalgia without first metatarsal involvement

De PJ, De PM, Forriol F

Language: Spanish
References: 30
Page: 411-416
PDF size: 161.40 Kb.


ABSTRACT

Objective: To analyze the clinical results of metatarsalgia treated with percutaneous distal metatarsal metaphyseal osteotomies (DMMO). Material and methods: Prospective and continuous study of 29 patients with isolated unilateral mechanical metatarsalgia, operated on with DMMO, with a mean follow-up of 38 months. The mean age of the patients was 58 (range: 50-67) years and only two men. We use the AOFAS score, we obtained the digital and metatarsal formulas on the X-rays. We record the subjective assessment of the surgeon and the patient at the end of the treatment. Results: The improvement in the final score exceeded 80 points in all cases (p = 0.000), with a significant improvement in pain (p = 0.000) and calluses (p = 0.000), improving metatarsal-phalangeal joint stability and interphalangeal and metatarsal alignment. The type of footwear did not change after surgery, we found no variation in mobility, neither in the metatarsophalangeal joints (p = 0.382), nor in the interphalangeal joints (p = 0.672). After surgery increased the square foot morphology (p = 0.027) but the metatarsal formula underwent few modifications. Patients and surgeons were in 96% of the cases "very satisfied" or "satisfied". Conclusion: DMMO achieves a high degree of satisfaction in patients and in the surgeon, pain and hyperkeratosis under the head of the painful metatarsals disappear and that significantly improves the functional capacity of patients.


REFERENCES

  1. Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. J Am Acad Orthop Surg. 2010; 18(8): 474-85.

  2. Espinosa N, Maceira E, Myerson MS. Current concept review: metatarsalgia. Foot Ankle Int. 2008; 29(8): 871-9.

  3. Diligent J, Diebold PF. Metatarsalgias estáticas. EMC - Podol. 2014; 16: 1-13.

  4. Besse JL. Metatarsalgia. Orthop Traumatol Surg Res. 2017; 103(1S): S29-S39.

  5. Loya K, Guimet M, Rockett MS. Proximal shortening lesser metatarsal osteotomy: a mathematical-geometric basis. J Foot Ankle Surg. 2000; 39(2): 104-13.

  6. Maestro M, Besse JL, Ragusa M, Berthonnaud E. Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin. 2003; 8(4): 695-710.

  7. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994; 15(7): 349-53.

  8. De Prado M, Ripoll PL, Golanó P. Cirugía percutánea del pie: técnicas quirúrgicas, indicaciones, bases anatómicas. Barcelona: Masson, 2003.

  9. Levanten EO, Pearson SW: Distal metatarsal osteotomy for intractable plantar keratoses. Foot Ankle. 1990; 10(5): 247-51.

  10. Lopez V, Slullitel G. Metatarsalgia: Assessment algorithm and decision making. Foot Ankle Clin. 2019; 24: 561-9.

  11. Hofmann UK, Gotze M, Wiesenreiter K, Müller O, Wünschel M, Mittag F. Transfer of plantar pressure from the medial to the central forefoot in patients with hallux valgus. BMC Musculoskelet Disord. 2019; 20(1): 149.

  12. Martínez-Ayora A, Cuervas-Mons Cantón M, Benjumea-Carrasco A, Arnal-Burró J, Sobrón-Caminero FB, Vaquero J. Tips, quips and pearls: Ultrasound-guided distal metatarsal minimal invasive osteotomy (US-DMMO). Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons. 2021; 27(1): 30-4.

  13. Biz C, Corradin M, Kuete Kanah WT, Dalmau-Pastor M, Zornetta A, Volpin A, et al. Medium-long-term clinical and radiographic outcomes of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for central primary metatarsalgia: do maestro criteria have a predictive value in the preoperative planning for this percutaneous technique? Biomed Res Int. 2018; 2018: 1947024.

  14. Bryant AR, Tinley P, Cole JH. Plantar pressure and radiographic changes to the forefoot after the Austin bunionectomy. J Am Podiatr Med Assoc. 2005; 95(4): 357-65.

  15. Meusnier T, Mukish P. Minimally invasive forefoot surgery in France. Foot Ankle Clin. 2016; 21(2): 351-65.

  16. Botezatu I, Marinescu R, Laptoiu D. Minimally invasive-percutaneous surgery - recent developments of the foot surgery techniques. J Med Life. 2015; 8: 87-93.

  17. Bauer T, de Lavigne C, Biau D, De Prado M, Isham S, Laffenétre O. Percutaneous hallux valgus surgery: a prospective multicenter study of 189 cases. Orthop Clin North Am. 2009; 40(4): 505-14.

  18. Derner R, Meyr AJ. Complications and salvage of elective central metatarsal osteotomies. Clin Podiatr Med Surg. 2009; 26(1): 23-35.

  19. Bauer T. Percutaneous forefoot surgery. Orthop Traumatol Surg Res. 2014; 100(Suppl): S191-204.

  20. Haque S, Kakwani R, Chadwick C, Davies MB, Blundell CM. Outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for lesser toe metatarsalgia. Foot Ankle Int. 2016; 37(1): 58-63.

  21. Redfern DJ, Vernois J. Percutaneous surgery for metatarsalgia and the lesser toes. Foot Ankle Clin. 2016; 21(3): 527-50.

  22. Magnan B, Bonetti I, Negri S, Maluta T, Dall'Oca C, Samaila E. Percutaneous distal osteotomy of lesser metatarsals (DMMO) for treatment of metatarsalgia with metatarsophalangeal instability. Foot Ankle Surg. 2018; 24(5): 400-5.

  23. Johansen JK, Jordan M, Thomas M. Clinical and radiological outcomes after Weil osteotomy compared to distal metatarsal metaphyseal osteotomy in the treatment of metatarsalgia. A prospective study. Foot Ankle Surg. 2019; 25(4): 488-94.

  24. Henry J, Besse JL, Fessy MH. Distal osteotomy of the lateral metatarsals: a series of 72 cases comparing the Weil osteotomy and the DMMO percutaneous osteotomy. Orthop Traumatol Surg Res. 2011; 97(Suppl): S57-65.

  25. Lopez-Vigil M, Suarez-Garnacho S, Martín V, Naranjo-Ruiz C, Rodriguez C. Evaluation of results after distal metatarsal osteotomy by minimal invasive surgery for the treatment of metatarsalgia: patient and anatomical pieces study. J Orthop Surg Res. 2019; 14: 121.

  26. Rivero-Santana A, Perestelo-Pérez L, Garcés G, Álvarez-Pérez Y, Escobar A, Serrano-Aguilar P. Clinical effectiveness and safety of Weil's osteotomy and distal metatarsal mini-invasive osteotomy (DMMO) in the treatment of metatarsalgia: a systematic review. Foot Ankle Surg. 2019; 25(5): 565-70.

  27. Nieto-García E, Ferrer-Torregrosa J, Ramírez-Andrés L, Nieto-González E, Martinez-Nova A, Barrios C. The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities. J Orthop Surg Res. 2019; 14(1): 308.

  28. Hofstaetter SG, Hofstaetter JG, Petroutsas JA, Gruber F, Ritschl P, Trnka HJ. The Weil osteotomy: a seven-year follow-up. J Bone Joint Surg Br. 2005; 87(11): 1507-11.

  29. Roukis TS. Percutaneous and minimum incision metatarsal osteotomies: a systematic review. J Foot Ankle Surg. 2009; 48(3): 380-7.

  30. Walker AK, Harris TG. The role of first ray insufficiency in the development of metatarsalgia. Foot Ankle Clin. 2019; 24(4): 641-8.



EVIDENCE LEVEL

IV




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