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Complications in Distal Minimally Invasive Metatarsal Osteotomies: Systematic Review and Meta-Analysis
Angélica María Fernández-Gómez1, Eduardo Nieto-García1, Leonor Ramírez-Andrés1
1Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, 46001 Valencia, Spain.
Abstract:
Background and Objectives: Minimally invasive distal metatarsal osteotomy (DMMO) has established itself as an effective surgical technique for the treatment of metatarsalgia, notable for its reduced postoperative pain and faster recovery. However, doubts remain regarding the frequency and nature of postoperative complications. The objective of this systematic review and meta-analysis was to evaluate the incidence of the most frequent complications associated with the DMMO technique, including prolonged edema, delayed bone healing, transfer metatarsalgia, floating toe, and persistent pain. Materials and Methods: A systematic review was conducted following the PRISMA 2020 guidelines, with the protocol registered in the PROSPERO database (CRD420251067666). Searches were conducted in the PubMed, Scopus, and Web of Science databases, including clinical studies published between 2010 and 2025. The inclusion criteria covered studies in adults treated with DMMO and reporting postoperative complications. The methodological quality assessment was performed using Joanna Briggs Institute (JBI) tools according to the design of each study. Random-effects models were used for the meta-analyses, assessing heterogeneity using the I2 statistic. Results: Fifteen studies with a total sample of more than 493 patients were included. Prolonged edema was the most common complication (30.91%), followed by delayed bone healing (14.9%), transfer metatarsalgia (12.73%), floating toe (10.45%), and persistent pain (8.5%). Less frequent complications included nonunion, infections, necrosis, and bone misalignments. The combined incidence of floating toe was 40% (I2 = 0%), while prolonged edema showed considerable heterogeneity (I2 = 88.3%). The overall quality of the evidence was considered moderate to low, mainly due to the predominance of observational studies. Conclusions: The DMMO technique represents a minimally invasive surgical option with generally favorable results. However, some complications, such as prolonged edema and floating toe, have a significant incidence. The methodological variability between studies highlights the need for standardized protocols and higher-quality prospective studies to establish the safety profile of this technique more accurately.
Insights
Minimally invasive distal metatarsal osteotomy (DMMO) offers benefits for metatarsalgia but carries risks. Prolonged edema and floating toe are common complications, necessitating further high-quality research to confirm safety.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Surgery
- Minimally Invasive Procedures
Background:
- Minimally invasive distal metatarsal osteotomy (DMMO) is an effective treatment for metatarsalgia, known for reduced pain and faster recovery.
- However, the frequency and nature of postoperative complications following DMMO require thorough investigation.
Purpose of the Study:
- To systematically review and meta-analyze the incidence of common complications after DMMO.
- Key complications evaluated include prolonged edema, delayed bone healing, transfer metatarsalgia, floating toe, and persistent pain.
Main Methods:
- Systematic review adhering to PRISMA 2020 guidelines, registered in PROSPERO.
- Searches of PubMed, Scopus, and Web of Science for studies from 2010-2025 involving adult DMMO patients.
- Meta-analysis using random-effects models and Joanna Briggs Institute tools for quality assessment.
Main Results:
- Fifteen studies with 493+ patients included. Most frequent complications: prolonged edema (30.91%), delayed bone healing (14.9%), transfer metatarsalgia (12.73%), floating toe (10.45%), and persistent pain (8.5%).
- Combined incidence of floating toe was 40% (I²=0%), while prolonged edema showed high heterogeneity (I²=88.3%).
- Overall evidence quality was moderate to low, primarily due to observational study predominance.
Conclusions:
- DMMO is a viable minimally invasive option for metatarsalgia, but significant complication rates for prolonged edema and floating toe exist.
- Methodological variability underscores the need for standardized protocols and high-quality prospective studies to better define the DMMO safety profile.
