Avascular necrosis of lesser metatarsal heads following forefoot surgery

Three cases of avascular necrosis of the lesser metatarsal heads following forefoot surgery are presented. The variable blood supply of the metatarsal heads is described. Interruption of this delicate circulation at the time of surgery is thought to be a major etiological factor. Repeated trauma following transference of load to the lesser metatarsal heads after operation may also play an important role. Although not previously described this may be a cause of persistent pain following surgery to the forefoot which is easily overlooked.