C. Kinast , M. Olos, A.Namazi

Pedographic and clinical results of percutaneous metatarsal osteotomies for metatarsalgia

Surgical technique:

Percutaneous metatarsal osteotomies PCMO 67 feetform dorsal distal to plantar proximal with a steep angle as possible < 45°same surgery: open hallux valgus reconstructionL-Austin ( Bevel ), Akin 52 feetLapidus Akin 8 feet Other previous surgery 1st ray 7 feet

M 2 3 OT n=12 feetM2 3 4 OT n=50 feetM3,4 n=1 feetM2 n=4 feet

percutanous hammertoe correction ( dePrado ) n = 42open PIP arthrodesis KW fixation 4 weeks n = 15

Prospectiv study design: patients with metatarsalgia, with and without hammertoesindex minus elevated pedographic pressure of M 2 ( novel emed )No plantar plate ruptureNo osteochondral lesions of MPJ 2 3 4 No clinical Morton´s syndrom

2009-F.B.

M1 P 1 osteotomy Lactosorb fixation

pc MOT 2 3; pc hammertoe correction M 5

pre

pre

post 1 year

post 1 year

pedography: novel emed

M2 P (pressure ) max kPA pre-post-differenceM2 post less than als pre n=60 feet -403 kPaM2 all n=67 feet -313 kPaM2 post more than preop n=7 feet +262 kPa

M 3 P max > M 2 P max n = 8 feet transfer-overload No clinical transfer metatarsalgia !!! so far

P max M2 average preop 969 kPA post op 652 kPA

Dynamic pedobarography was performed using theEMED-SF1 pressure platform (Novel GmbH, Munich,Germany) with a spatial resolution of four sensors per cm2.Measurements at 50-Hz sample frequency were used toobtain barefoot plantar pressures. Each subject was testedusing the two-step method in which platform contact wasmade on the second step after initiation of gait

Clinical examination: 1 year minimum follow up

metatarsalgia: none

sensory disturbance : 5 feet at 1 year

P 2 spontanous floor contact 61 feet

P2 floor contact with active plantarflexion

x-ray:

healing without significant callus 24 feethealing with severe callus 41 feet incomplete healing visible osteotomy gap after 1 year 2

Summary:

percutaneous osteotomies M 2 3 4

Pedography max pressure was decreased from P max M2 average preop 969 kPA post op 652 kPA in 60 feet7 feet no decrease

floorcontact of Z2 3 4 was positive in most of the feet

subcapital osteotomies heal faster as more proximal osteotomies

Metatarsalgia was successfully treated