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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.

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|August 28, 2025
PubMed
Summary

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.

Keywords:
DMMO (distal minimally invasive metatarsal osteotomy)MIS (minimally invasive surgery)complicationsmeta-analysismetatarsalgia

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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.