Clinical and radiological outcomes after Weil osteotomy compared to distal metatarsal metaphyseal osteotomy in the treatment of metatarsalgia—A prospective study
Introduction
Static metatarsalgia of the forefoot is a frequent condition and is in many cases a sequelae to first ray deficiency. Metatarsalgia means pain and tenderness in the forefoot and below the metatarsal heads. There are many causes of metatarsalgia, and it can be difficult to treat adequately. Prevalence of metatarsalgia is approximately 10% in a population, with a female preponderance [1]. First line treatment of metatarsalgia is non-operative with orthotics or cushioning, but when non-operative management fails, surgery may be indicated [2]. Surgery aims at shortening and raising the metatarsal head in order to relieve pressure under the metatarsal heads and restoring ideal forefoot morphology [3], [4].
The Weil osteotomy (WO) is an intra-articular osteotomy widely used in surgical treatment of metatarsalgia, but also resulting in stiffness of the metatarsophalangeal joint (MTPJ) in up to 30% of the patients. Elevation of the toe postoperatively was found in 25–33% of the patients after the Weil procedure [4], [5], [6]. Highlander et al. [7] reported floating toe in 36%, recurrence of metatarsalgia in 15% and transfer metatarsalgia in 7% of the patients operated with the WO. The WO has for many years been the most popular distal lesser metatarsal osteotomy for treating imbalance of the forefoot and static metatarsalgia [8].
The distal metatarsal metaphyseal osteotomy (DMMO) is an extraarticular osteotomy performed using minimally invasive technique which theorectically results in less postoperative stiffness and may therefore represent a viable alternative to the WO in treating metatarsalgia operatively [1], [8], [9], [10], [11]. Henry et al. [4] found no differences in outcome when comparing the two methods regarding joint stiffness, but longer recovery time in the DMMO group. Dhukaran et al. [12] found a minimal risk of neurovascular and tendon injury associated with minimally invasive techniques in the forefoot.
The DMMO is gaining popularity, but clinical studies are scarce.
Section snippets
Aims
The aim of this study is to compare the outcome of the WO and the DMMO regarding function, complications and patient satisfaction at six weeks postoperatively, and at a final follow-up minimum six months after index surgery, at an average 13 months follow-up postoperatively.
The aim of this article is to provide data in order to allow surgeons a better base for decision making when choosing between open surgery and minimally invasive surgery in the forefoot.
Material and methods
A manual search through all surgical reports for WOs performed between 1/8/2009 and 5/8/2011 were carried out ().
The first 30 patients who had the WO performed and had at least six months clinical follow-up and radiologic assessment at six months post-op were included (Group A).
A manual search through all surgical reports between 1/1/2014 and 17/9/2014 for DMMOs was performed.
The first 30 patients who had the DMMO performed and had at least 6 months clinical follow-up and radiologic assessment
Demography and patient characteristics
Group A, WO Group, consisted of 30 patients with a total of 45 WOs.
Group B, DMMO Group, consisted of 30 patients with a total of 73 DMMOs.
General information regarding Group A and Group B is displayed in Table 1.
Group A and B were comparable regarding age, gender, follow-up period and surgery performed on the first ray. The average surgery time was 36 min, 95% CI: 17–54, P < 0.001 shorter and the average tourniquet time was 27 min, 95% CI: 12–42, P < 0.001 shorter for the DMMO procedure in Group B,
Discussion
The WO is an intra-articular, non-dynamic, open distal osteotomy requiring internal fixation. The aim is to shorten and elevate the metatarsal head [16]. The shortening and elevation of the metatarsal head aim at off-loading the forefoot and relieving metatarsalgia. Vandeputte et al. [17] found a significantly decreased load under the metatarsal heads after the WO. Other studies have shown no decrease or even increase in load under the metatarsal head after the WO [18].
The DMMO is an
Conclusion
Compared to the Weil procedure the duration of surgery and tourniquet times were significantly shorter and hypertrophic scarring was less prevalent for the DMMO procedure. The radiation time was significantly longer in the DMMO group. VAS-FA scores increased significantly following surgery and no differences were detected between procedures.
The DMMO offers a good alternative to the WO in treating static metatarsalgia. It is a safe procedure with few complications and with good clinical outcome.
Conflicts of interest
The authors declare no conflicts of interest associated with this publication.
Acknowledgements
Miss Sarah Schutz for supporting the authors in conducting the phone interviews in November 2016. MD, Ph.D. Dennis Winge Hallager for statistical analysis.
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Cited by (22)
Lateral metatarsal osteotomy
2024, Orthopaedics and Traumatology: Surgery and ResearchLateral metatarsal osteotomy
2023, Revue de Chirurgie Orthopedique et TraumatologiqueComplications in minimally invasive foot and ankle surgery: prevention and resolution
2023, Fuss und SprunggelenkRisks of injury in distal metatarsal minimally invasive osteotomy when comparing standard and modified techniques: A cadaveric study
2022, Foot and Ankle SurgeryCitation Excerpt :Good outcome were described, although high complication percentages were also observed [11–14]. New percutaneous techniques, especially distal metatarsal mini-invasive osteotomy (DMMO), aim to reduce these problems through smaller incisions and reduced surgical time [15–18]. DMMO is an extraarticular osteotomy, with minimal soft tissue dissection, permitting elevation as well as proximal displacement of the metatarsal head [19,20].
Metatarsalgia: DMMO
2022, Fuss und Sprunggelenk
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