Asymmetric "V" osteotomy: a predictable surgical approach for chronic central metatarsalgia

Chronic metatarsalgia is a condition found through the years to present many treatment difficulties. These difficulties began with a lack of understanding, not only concerning the etiologic nature of this condition, but failure to appreciate the surgical treatment ramifications inherent to alterations in the metatarsal parabola. These failures have subsequently led to lesions under the adjacent metatarsal heads, stress fractures, flail toes, and other postoperative pathology. This often leads to further surgical intervention or accommodative modifications. The authors offer an analysis of surgical approaches to this problem and present a more predictable surgical technique to enhance the metatarsal parabola, while decreasing either excessive plantarflexion of a particular metatarsal or set of metatarsals. To date the senior author (E.L.) has performed the asymmetric "V" osteotomy on 30 patients for a total of 40 metatarsals. After a 12- to 18-month postoperative period, there have been no significant complications, including recurrences, transfer lesions, excessive secondary bone callous, malunions, or adjacent metatarsalgia. Delayed union with secondary bone callous has developed in two instances. The authors introduce an innovative surgical approach to structural metatarsal abnormalities as a distinct advantage to other previously described osteotomies with greater predictability, better anatomic reduction, primary bone healing, and faster return to normal activities.