Predictive value of radiographic measurements compared to clinical examination

The use of metatarsal osteotomies in the treatment of metatarsalgia is controversial, as is the best location of the osteotomies to prevent transfer metatarsalgia. To determine if metatarsal osteotomies used in forefoot reconstruction to restore the normal anatomical curve would decrease the risk of transfer metatarsalgia, the clinical outcomes of such osteotomies were correlated with the preoperative planning.

Between 2000 and 2005, 63 patients (73 feet) with persistent metatarsalgia had forefoot reconstructions that included one or more Weil osteotomies designed to restore the theoretically ideal foot morphotype described by Maestro et al. and based on the relative lengths of the lesser rays.

The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score of 36.2 improved to 82.2 postoperatively. Sixty-two (85%) of the 73 feet were pain-free after surgery.

In spite of careful preoperative planning, it was difficult to obtain the ideal foot type, and the frequency of transfer metatarsalgia in our patients was similar to that reported in the literature. A significant (p = 0.03) relationship was identified between the amount of preoperative instability and the risk of developing transfer metatarsalgia. Preoperative dorsoplantar standing radiographs, although helpful in planning surgery to obtain appropriate metatarsal lengths, should not be the only method used for operative planning.