[Helal's metatarsal osteotomy. Indication and technic with reference to shape and function of the foot]

Metatarsal osteotomy according to Helal is a successful method of treating metatarsalgia. Using this method, 72% of our patients, followed up between 1974 and 1986, (114 patients with a total of 336 osteotomies) were relieved of pain, the result depending on the patients' age. On reviewing the unsuccessful results using pedobarographic measuring, the major part of failures was due to an unequal distribution of weight on the forefoot. Two main types of faulty weight-bearing were stated: 1. Excessive weight-bearing on non-osteotomized adjacent metatarsals (domino-effect). In concern of the overall-result no difference could be found between cases with routine osteotomy II-IV and ones with single or double osteotomy. 2. Excessive weight-bearing on the complete fore-foot as a consequence of missing support by contracted metatarsophalangeal joints. When planning an operation, the length of all metatarsals in relation to each other, as well as the mobility of the toes should therefore be taken into consideration.