Significance of the suspensory and collateral ligaments in lesser metatarsal neck surgery

In this study the authors have endeavored to define more closely the distinct nature of the collateral and suspensory ligaments of the lesser metatarsophalangeal joints and to propose a mechanism through which the ligaments confer stability to the metatarsal head. The lesser metatarsal neck dorsal V-osteotomy is one surgical procedure that has the potential of disrupting the intracapsular ligaments, depending on the placement of the "V" cut. The angulation of the "V" cut redirects the capital fragment in the sagittal plane while maintaining stability in the transverse and frontal planes. The authors contend that the sagittal stability of the free capital fragment after a V-osteotomy is maintained, as well, by the attachment of the newly defined suspensory ligaments and the collateral ligaments of the metatarsophalangeal joint. Disruption of these ligaments, such as occurs when placing the apex of the V-osteotomy proximally, serves to increase the instability within the metatarsal head, ultimately leading to a potential increase in number of complications.