Distal osteotomy of the lateral metatarsals: a series of 72 cases comparing the Weil osteotomy and the DMMO percutaneous osteotomy

Abstract

Introduction: A Weil osteotomy with internal fixation can match the preoperative plan by precisely setting the metatarsal length; however 10 to 30% of patients end up experiencing postoperative stiffness. A percutaneous distal metatarsal mini-invasive osteotomy (DMMO) is a purely extra-articular technique; metatarsal length is set automatically upon weight bearing of the foot. The goal of this study was to compare these two osteotomy techniques when performed on the three or four most lateral metatarsals.

Hypothesis: A DMMO will result in better joint motion than a Weil osteotomy.

Patients and methods: This was a retrospective, single center, single surgeon study with 72 patients. Group 1 consisted of 39 patients operated by the DMMO technique. Group 2 consisted of 33 patients operated by the standard Weil osteotomy technique. In some cases, a procedure on the first ray (Scarf or fusion) was also performed. The age, gender and procedures on the first ray were comparable for both groups. Patients were evaluated with clinical (AOFAS score) and radiological outcomes (Maestro criteria) at 3 and 12 months minimum follow-up.

Results: Sixty-seven patients were seen again with an average follow-up of 14.8 months (range 12-24). The postoperative AOFAS score was comparable in both groups (86.5 and 85.3, respectively). The joint range of motion was comparable in both groups. Static problems (oedema, metatarsalgia, hyperkeratosis and dislocation) were comparable at the last follow-up. The metatarsalgia recurred in four patients from group 1 and five patients from group 2. After 3 months, oedema and metatarsalgia were significantly greater in group 1. Radiological measurements (M1P1angle, M1M2angle and Maestro criteria) were comparable. Metatarsal head recoil was identical between each ray in group 1. At the last follow-up, all the osteotomy sites had achieved union.

Discussion and conclusion: The results of static metatarsalgia treatment were comparable when using a DMMO or Weil osteotomy. However the DMMO had longer postoperative recovery, notably because of oedema. The percutaneous DMMO technique did not improve joint range of motion.

Level of evidence: III, comparative retrospective study.

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