Results of distal metatarsal osteotomy using absorbable pin fixation

Metatarsalgia with plantar hyperkeratosis can be a difficult problem to treat. Many different techniques have been reported with the Weil osteotomy very popular currently. Despite good results complications include metatarsophalangeal stiffness, hyperextension of the toe, prehensile deficit and a reduction in strength. We evaluated our results with a distal diaphyseal osteotomy.

From 1999 to 2005, we performed 66 distal midshaft subtraction osteotomies in 62 patients suffering from metatarsal overload without metatarsophalangeal subluxation. Fixation was obtained with an absorbable pin. Some patients underwent simultaneous corrective surgery for hallux valgus, hallux rigidus or lesser toe deformities. There was an average of 18 months followup.

The mean preoperative Maryland score was 52; the mean postoperative score was 86. Seventy-two percent of the patients were very satisfied and 28% felt their condition improved with only occasional pain (VAS 2 to 4). The only complications reported was a loss of correction due to breakage of the pins in three patients (two sustained trauma and the third began walking prematurely without a postoperative shoe).

The good clinical results obtained and the low incidence of complications have encouraged us to use this technique to treat symptomatic metatarsal overload. Surgical accuracy, adherence to the postoperative regimen and, where necessary, adequate correction of the first ray were important factors for success.