Incidence of Floating Toe After Distal Minimally Invasive Metatarsal Osteotomy with Pin Osteosynthesis for the Treatment of Metatarsalgia and Rigid Hammertoe
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Published:
Apr 16, 2024
Keywords:
Metatarsalgia, hammertoe, distal metatarsal metaphyseal osteotomy, proximal interphalangeal arthrodesis, floating toe
Main Article Content
Abstract
Introduction: Central metatarsalgia is a common cause of forefoot pain. The most common surgical treatment is Weil osteotomy and the most popular percutaneous technique is distal minimally invasive metatarsal osteotomy (DMMO). However, the main disadvantage of these techniques is the appearance of floating toes, which is even greater when associated with proximal interphalangeal arthrodesis. In this series of cases, DMMO was combined with a pin to elevate the center of rotation of the metatarsal head with the aim of reducing the presence of floating toes. Our main hypothesis was that this technique would result in a lower presence of floating toes in patients diagnosed with mechanical metatarsalgia and rigid hammertoe, compared to Weil osteotomies.
Materials and Methods: A retrospective observational study was carried out on consecutive adult patients diagnosed with mechanical metatarsalgia and rigid hammertoe. DMMO was performed with pin fixation in combination with proximal interphalangeal (PIP) arthrodesis. Finally, the presence of floating toes was compared with a group of patients operated on with the Weil technique and PIP arthrodesis.
Results: A total of 39 DMMOs with PIP arthrodesis were performed. The percentage of floating toes was 31% . There was no statistically significant difference compared to the Weil technique (36%, p = 0.634).
Conclusion: DMMO for elevation of the center of rotation associated with PIP arthrodesis fixed with a pin did not provide a lower incidence of floating toes compared to Weil osteotomy.
Materials and Methods: A retrospective observational study was carried out on consecutive adult patients diagnosed with mechanical metatarsalgia and rigid hammertoe. DMMO was performed with pin fixation in combination with proximal interphalangeal (PIP) arthrodesis. Finally, the presence of floating toes was compared with a group of patients operated on with the Weil technique and PIP arthrodesis.
Results: A total of 39 DMMOs with PIP arthrodesis were performed. The percentage of floating toes was 31% . There was no statistically significant difference compared to the Weil technique (36%, p = 0.634).
Conclusion: DMMO for elevation of the center of rotation associated with PIP arthrodesis fixed with a pin did not provide a lower incidence of floating toes compared to Weil osteotomy.
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Bilbao, F., Cafruni, V. M., Cardone, G., Villena, D. S., Verbner, J. M., & Carrasco , N. M. (2024). Incidence of Floating Toe After Distal Minimally Invasive Metatarsal Osteotomy with Pin Osteosynthesis for the Treatment of Metatarsalgia and Rigid Hammertoe. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(2), 96-104. https://doi.org/10.15417/issn.1852-7434.2024.89.2.1778
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Clinical Research
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References
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12. Henry J, Besse JL, Fessy MH, AFCP. 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(6 Suppl):S57-65. https://doi.org/10.1016/j.otsr.2011.07.003
13. Trnka HJ, Nyska M, Parks BG, Myerson MS. Dorsiflexion contracture after the Weil osteotomy: results of cadaver study and three-dimensional analysis. Foot Ankle Int 2001;22(1):47-50. https://doi.org/10.1177/107110070102200107
14. Maestro M, Besse J-L, Ragusa M, Berthonnaud E. Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin 2003;8(4):695-710. https://doi.org/10.1016/s1083-7515(03)00148-7
15. Ferrández Portal L, Fernández Sabaté A, Rodríguez Merchán EC, Pérez-Caballer Pérez A, Gómez-Castresana Bachiller F, Cáceres Palou E. Metatarsalgias. En: Manual SECOT de Cirugía Ortopédica y Traumatología (Spanish Edition). Buenos Aires: Editorial Médica Panamericana S.A.; 2003:684-98.
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19. Gregg J, Silberstein M, Clark C, Schneider T. Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability. Foot Ankle Surg 2007;13(3):116-21. https://doi.org/10.1016/j.fas.2007.01.001
20. 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. https://doi.org/10.1302/0301-620X.87B11.16590
21. Yeo NEM, Loh B, Chen JY, Yew AKS, Ng SY. Comparison of early outcome of Weil osteotomy and distal
metatarsal mini-invasive osteotomy for lesser toe metatarsalgia. J Orthop Surg (Hong Kong) 2016;24(3):350-3. https://doi.org/10.1177/1602400315
22. 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. https://doi.org/10.1016/j.fas.2018.03.002
23. 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.
https://doi.org/10.1016/j.fas.2018.06.004
2. Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. J Am Acad Orthop Surg 2010;18(8):474-85.
https://doi.org/10.5435/00124635-201008000-00004
3. Feibel JB, Tisdel CL, Donley BG. Lesser metatarsal osteotomies. A biomechanical approach to metatarsalgia. Foot Ankle Clin 2001;6(3):473-89. https://doi.org/10.1016/s1083-7515(03)00108-6
4. Pearce CJ, Calder JD. Metatarsalgia: proximal metatarsal osteotomies. Foot Ankle Clin 2011;16(4):597-608. https://doi.org/10.1016/j.fcl.2011.08.007
5. Schuh R, Trnka HJ. Metatarsalgia: distal metatarsal osteotomies. Foot Ankle Clin 2011;16(4):583-95.
https://doi.org/10.1016/j.fcl.2011.08.009
6. Barouk LS. [Weil’s metatarsal osteotomy in the treatment of metatarsalgia]. Orthopade 1996;25(4):338-44. https://doi.org/10.1007/s001320050034
7. Vandeputte G, Dereymaeker G, Steenwerckx A, Peeraer L. The Weil osteotomy of the lesser metatarsals: a clinical and pedobarographic follow-up study. Foot Ankle Int 2000;21(5):370-4. https://doi.org/10.1177/107110070002100502
8. Migues A, Slullitel G, Bilbao F, Carrasco M, Solari G. Floating-toe deformity as a complication of the Weil
osteotomy. Foot Ankle Int 2004;25(9):609-13. https://doi.org/10.1177/107110070402500902
9. Garg R, Thordarson DB, Schrumpf M, Castaneda D. Sliding oblique versus segmental resection osteotomies for lesser metatarsophalangeal joint pathology. Foot Ankle Int 2008;29(10):1009-14.
https://doi.org/10.3113/FAI.2008.1009
10. Highlander P, Von Herbulis E, Gonzalez A, Britt J, Buchman J. Complications of the Weil osteotomy. Foot Ankle Spec 2011;4(3):165-70. https://doi.org/10.1177/1938640011402822
11. Botezatu I, Marinescu R, Laptoiu D. Minimally invasive-percutaneous surgery - recent developments of the foot surgery techniques. J Med Life 2015;8 Spec Issue:87-93. PMID: 26361518
12. Henry J, Besse JL, Fessy MH, AFCP. 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(6 Suppl):S57-65. https://doi.org/10.1016/j.otsr.2011.07.003
13. Trnka HJ, Nyska M, Parks BG, Myerson MS. Dorsiflexion contracture after the Weil osteotomy: results of cadaver study and three-dimensional analysis. Foot Ankle Int 2001;22(1):47-50. https://doi.org/10.1177/107110070102200107
14. Maestro M, Besse J-L, Ragusa M, Berthonnaud E. Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin 2003;8(4):695-710. https://doi.org/10.1016/s1083-7515(03)00148-7
15. Ferrández Portal L, Fernández Sabaté A, Rodríguez Merchán EC, Pérez-Caballer Pérez A, Gómez-Castresana Bachiller F, Cáceres Palou E. Metatarsalgias. En: Manual SECOT de Cirugía Ortopédica y Traumatología (Spanish Edition). Buenos Aires: Editorial Médica Panamericana S.A.; 2003:684-98.
16. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15(7):349-53. https://doi.org/10.1177/107110079401500701
17. Monteagudo M, Maceira E. Evolution of the weil osteotomy: the triple osteotomy. Foot Ankle Clin 2019;24(4):599-614. https://doi.org/10.1016/j.fcl.2019.08.009
18. Coughlin MJ, Baumfeld DS, Nery C. Second MTP joint instability: grading of the deformity and description of surgical repair of capsular insufficiency. Phys Sports Med 2011;39(3):132-41. https://doi.org/10.3810/psm.2011.09.1929
19. Gregg J, Silberstein M, Clark C, Schneider T. Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability. Foot Ankle Surg 2007;13(3):116-21. https://doi.org/10.1016/j.fas.2007.01.001
20. 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. https://doi.org/10.1302/0301-620X.87B11.16590
21. Yeo NEM, Loh B, Chen JY, Yew AKS, Ng SY. Comparison of early outcome of Weil osteotomy and distal
metatarsal mini-invasive osteotomy for lesser toe metatarsalgia. J Orthop Surg (Hong Kong) 2016;24(3):350-3. https://doi.org/10.1177/1602400315
22. 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. https://doi.org/10.1016/j.fas.2018.03.002
23. 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.
https://doi.org/10.1016/j.fas.2018.06.004