Treatment of Metatarsalgia with Distal Osteotomies

Many different distal metatarsal osteotomies have been described in the surgical treatment of metatarsalgia. The surgeon should use such osteotomies judiciously, and indeed, in the author's experience, they are infrequently required and are certainly not a first port of call. In cases where nonoperative treatments have failed, a thorough understanding of the causes of metatarsalgia and a detailed clinical assessment of the patient are essential if good surgical outcomes are to be achieved. If using distal metatarsal osteotomies as part of the surgical plan, then the author favors extra-articular percutaneous osteotomies to minimize postoperative stiffness.