Oblique sliding metatarsal osteotomy for pressure metatarsalgia

The transverse arch of the foot is formed by metatarsals which heads lie in a straight line to endure most of the loading of the forefoot. Malalignment of one or more metatarsal heads will result in increased loading and produce local tender plantar callosity. The treatment of pressure metatarsalgia must aim for it's pathomechanic cause, that is, hyper-extension of metatarsophalangeal joint. We have modified the distal metatarsal osteotomy to treat 40 toes in 22 cases. Follow up for an average of 21.3 months (ranging from 18 months to 31 months) indicated 19 cases (86.4%) with satisfactory results. The 3 cases with unsatisfied results were all due to early removal of the pin. Maximum oblige sloping of the osteotomy makes the osteotomy slide more easily and ensures union. Intramedullary pinning and early weight bearing maintain the osteotomic alignment, prevent foot stiffness and allow the distal fragment telescopes to be adequately positioned to prevent over correction which leads to transfer lesion. Compared to other methods, modified metatarsal osteotomy is less invasive, preserves natural structure, is easily performed and easy cared for which leads to effective and stable results.