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Chirurgia del Piede 2010 August;34(2):71-83


language: Italian

Extra-articular distal metatarsal osteotomy in the treatment of biomechanical metatarsalgia of the external ray

Pisani G. 1, Pisani P. C. 1, Parino E. 1, Bratulich A. 2

1 Centro di Chirurgia del Piede “Prof. G. Pisani”, Clinica “Fornaca di Sessant”, Torino 2 2 Ospedale S. Croce e Carle, Cuneo


A review of the literature shows that there are numerous techniques in lateral metatarsal osteotomy for treating biomechanical metatarsalgia, yet few studies clearly indicate the superiority of one technique over another as outcomes after surgery are difficult to compare due to differences in assessment methods and patient inclusion criteria. Furthermore, of the few studies comparing surgical techniques and treatment outcomes, noteworthy is that by Trnka et al. which demonstrated the superiority of the Weil over the Helal osteotomy based on clinical outcomes. The literature review also revealed that use of the Weil osteotomy, which had gained wide acceptance in the 1990s, has since then been restricted to selected indications. Results after dorsoplantar extra-articular distal osteotomy (V-shaped cut with apex distal) performed at our Center have shown it to be an optimal technique with statistically demonstrated clinical effectiveness (91% good or fair results; 86% patient satisfaction) and outcomes (according to assessment methods and inclusion criteria) comparable with those obtained by Kitaoka et al. in the evaluation of chevron osteotomy (88% good or fair results). No cases of delayed bone healing or pseudarthrosis occurred after synthesis with resilient wedges in 41 of 55 osteotomies, demonstrating this technique’s validity. An important consideration is that the operator needs to carefully assess patients who have previously undergone forefoot surgery since metatarsalgia has a complicated etiopathogenesis in these cases and the risk of inappropriate treatment with serious complications is high. Also of importance is that, although this surgical technique may appear straightforward at first glance, the etiopathogenesis of the biomechanical metatarsalgia syndrome is notoriously complex. The outcome will therefore depend on the surgeon’s skillfully combining all assessment elements (knowledge of foot anatomy and biomechanics, patient’s medical history, clinical and diagnostic workup, choice of surgical technique, surgical experience) into the surgical act. In other words, compared to other technically simple interventions, this procedure harbors numerous pitfalls that warrant caution and prudence in the young surgeon.

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