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Abstract
Metatarsalgia means the pain under the lesser metatarsal heads. The many causes of metatarsalgia can be categorized into three groups: local disease in the region, altered forefoot biomechanics, and systemic disease affecting the region. Surgical options need to be considered if nonsurgical treatment fails. The metatarsal osteotomies are designed primarily to reduce the weightbearing forces on the metatarsal head by elevating or shortening the metatarsal. Many lesser metatarsal osteotomies have been described, and their success depends on many factors. Regardless of the method employed, it is important to maintain or restore the metatarsal cascade to maintain an even pressure under the lesser metatarsal heads and prevent transfer lesions. The surgeon must understand the effects of the metatarsal osteotomy on the forefoot patho-biomechanics and decide, using a combination of clinical examinations and imaging, whether the desired effect of the osteotomy is to shorten or elevate the metatarsal head or both.
Figures and Tables
Figure 1
Schematic figures of variable metatarsal osteotomies: Distal oblique metatarsal neck osteotomy by Weil (A), distal metatarsal metaphyseal osteotomy (DMMO) by Redfern (B), distal oblique osteotomy by Helal (C), distal metatarsal wedge out osteotomy by Leventen and Pearson (D), proximal metatarsal wedge out osteotomy by Fleischli (E), and distal chevron osteotomy by Kitaoka and Patzer (F).
Figure 2
When the angle of the Weil osteotomy is more vertical than the weightbearing surface of the foot, plantar displacement of the metatarsal head during the shortening of the metatarsal will coincide.
Table 1
Different Types of Metatarsalgia
Data from the article of Espinosa et al. (Foot Ankle Int. 2008;29:871–9).2)
MP: metatarso-phalangeal.
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