Metatarsalgia: proximal metatarsal osteotomies

Area of Science:

• Orthopedic surgery
• Podiatric medicine
• Biomechanics

Background:

• Metatarsalgia is a common forefoot pain condition with diverse etiologies.
• It disproportionately affects women and often necessitates a comprehensive diagnostic approach.
• Nonsurgical treatments are typically the first line of management.

Purpose of the Study:

• To review the current landscape of metatarsal osteotomies for metatarsalgia.
• To highlight the lack of comparative evidence for different surgical techniques.
• To emphasize the importance of surgical decision-making based on clinical and imaging findings.

Main Methods:

• Review of existing literature on metatarsal osteotomies.
• Analysis of surgical goals: shortening, elevation, or both, of the metatarsal head.
• Consideration of proximal versus distal osteotomies and the role of fixation.

Main Results:

• Numerous lesser metatarsal osteotomies exist with limited comparative data.
• Proximal osteotomies offer greater power but can be more technically challenging.
• Fixation appears to improve union rates, symptom relief, and prevention of transfer pain.

Conclusions:

• The choice of metatarsal osteotomy is largely based on surgeon preference due to a lack of evidence.
• Maintaining the metatarsal cascade is crucial for preventing transfer lesions.
• Further research is needed to compare osteotomy techniques for efficacy and complication rates.