Three-Dimensional Corrective Osteotomy for a Longstanding Multiplanar Fifth Metatarsal Deformity in an Older Adult: A...

A 75-year-old man presented with a longstanding deformity of the right fifth metatarsal. He had undergone surgery for a congenital toe deformity in early childhood. The fifth metatarsal was shortened and showed lateral displacement, plantar flexion, and external rotation. These deformities resulted in a painful plantar-lateral prominence, callus formation, and difficulty wearing conventional footwear. A three-dimensional corrective osteotomy based on the medial and dorsal translation principles of the long scarfette osteotomy was performed, with an additional asymmetric wedge resection for rotational correction. At the three-year follow-up, bone union had been achieved, the prominence and callus had resolved, and the patient was able to walk without pain and wear conventional footwear comfortably. Residual shortening of the fifth ray caused no functional complaint. This case illustrates a practical approach to the three-dimensional assessment of a complex metatarsal deformity and the correction of each component in the transverse, sagittal, and axial planes.