Minimally invasive osteotomies of the second and third metatarsals for the management of metatarsalgia in hallux valgus with plantar plate rupture.

Background: Distal Minimally invasive metatarsal osteotomies (DMMOs) shorten the metatarsals While allowing automatic adjustment of the metatarsal heads in all three planes through immediate weight-bearing. In hallux valgus (HV) surgery, transfer metatarsalgia can be managed with percutaneous DMMOs.

Purpose: This study is a retrospective study that evaluates the clinical and radiological outcomes of DMMOs limited to the second and third metatarsals for metatarsalgia with plantar plate injury associated with HV.

Study design: A single-center study of 102 patients who underwent surgery between 2011 and 2020.

Methods: Demographic, radiological, clinical (AOFAS score), and complication data were analyzed. Minimally invasive DMMOs of the second and third metatarsals were performed under fluoroscopic guidance, followed by a chevron osteotomy of M1 to realign forefoot length.

Results: We observed significant metatarsal shortening and AOFAS a signifiant improvement (p < 0.05) with a postoperative value of 92.25 ± 3.7 (range: 71.2-98.2). No recurrences, three cases of transfer metatarsalgia, and six delayed unions were reported DMMOs of the second and third metatarsals appear to be a reliable option for treating metatarsalgia with plantar plate injury in HV.

Conclusion: DMMOs of the second and third metatarsals appear to be a reliable option for treating metatarsalgia with plantar plate injury in association with surgical correction of HV. We observed no recurrence of metatarsalgia, and the risk of transfer metatarsalgia was less than 2.9.