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Lesser Metatarsal Osteotomies
Lesser Metatarsal Osteotomies
Training Program for Podiatry Residents
2nd Metatarsal OsteotomyCauses of Metatarsalgia
22ndnd Metatarsal Metatarsal OsteotomyOsteotomyCauses of Causes of MetatarsalgiaMetatarsalgia
• Bone Causes– Prominent fibular condyle– Long metatarsal– Hypermobile 1st ray– Post trauma– Abnormal foot posture
• Systemic Diseases– Rheumatoid arthritis– Psoriatic arthritis
• Dermatologic Lesions– Wart– Seed corn– hyperkeratosis
• Bone Causes– Prominent fibular condyle– Long metatarsal– Hypermobile 1st ray– Post trauma– Abnormal foot posture
• Systemic Diseases– Rheumatoid arthritis– Psoriatic arthritis
• Dermatologic Lesions– Wart– Seed corn– hyperkeratosis
• Soft Tissue Causes• Equinus• Atrophic fat pad• Crush injury sequelae• Plantar scar
• Mechanical Causes• Subluxed/dislocated MTP• Hallux valgus
• Iatrogenic Causes• Metatarsal surgery• Transfer lesion• Hallux valgus surgery
4th Annual International External Fixation Symposium
December 11-14, 2008
1
2nd Metatarsal OsteotomyFunctional Anatomy
22ndnd Metatarsal Metatarsal OsteotomyOsteotomyFunctional AnatomyFunctional Anatomy
• Stance phase: 62%• Swing phase: 38%• Forefoot in contact
with WB surface from foot flat to toe off
• 1st,4th,5th metatarsals mobile in sagittalplane
• 2nd & 3rd metatarsals relatively fixed
• Stance phase: 62%• Swing phase: 38%• Forefoot in contact
with WB surface from foot flat to toe off
• 1st,4th,5th metatarsals mobile in sagittalplane
• 2nd & 3rd metatarsals relatively fixed
2nd Metatarsal OsteotomyClinical Assessment
22ndnd Metatarsal Metatarsal OsteotomyOsteotomyClinical AssessmentClinical Assessment
• Palpation across plantar forefoot
• Vertical stress test of MTP• Mulder’s test• Evaluation of deformities• Diagnostic injections• Advanced imaging
• Palpation across plantar forefoot
• Vertical stress test of MTP• Mulder’s test• Evaluation of deformities• Diagnostic injections• Advanced imaging
4th Annual International External Fixation Symposium
December 11-14, 2008
2
2nd Metatarsal OsteotomyRadiographic Assessment
22ndnd Metatarsal Metatarsal OsteotomyOsteotomyRadiographic AssessmentRadiographic Assessment
• Xrays– Examine parabola– Metatarsal position– MTP subluxation
• MRI– Rarely indicated– Evaluate plantar plate– Space occupying
lesion
• Xrays– Examine parabola– Metatarsal position– MTP subluxation
• MRI– Rarely indicated– Evaluate plantar plate– Space occupying
lesion
2nd Metatarsal OsteotomyIndications/Contraindications
22ndnd Metatarsal Metatarsal OsteotomyOsteotomyIndications/ContraindicationsIndications/Contraindications
• Indications– Long metatarsal– Plantarflexed metatarsal– Angular deformity of metatarsal– Contracted digit that can’t be reduced without MTP
decompression• Contraindications
– Diffuse Plantar callous formation– Pain of unknown etiology– Prophylactic/cosmetic surgery
• Indications– Long metatarsal– Plantarflexed metatarsal– Angular deformity of metatarsal– Contracted digit that can’t be reduced without MTP
decompression• Contraindications
– Diffuse Plantar callous formation– Pain of unknown etiology– Prophylactic/cosmetic surgery
4th Annual International External Fixation Symposium
December 11-14, 2008
3
2nd Metatarsal OsteotomyProcedures
22ndnd Metatarsal Metatarsal OsteotomyOsteotomyProceduresProcedures
• DuVries Condylectomy• Closing Wedge
– Proximal– Distal– Midshaft
• Chevron• Step-cut • Cylindrical• Helal• Weil
• DuVries Condylectomy• Closing Wedge
– Proximal– Distal– Midshaft
• Chevron• Step-cut • Cylindrical• Helal• Weil
2nd Metatarsal OsteotomySurgical Technique
22ndnd Metatarsal Metatarsal OsteotomyOsteotomySurgical TechniqueSurgical Technique
• 25-40° from long axis of metatarsal
• Parallel to WB surface• Decreases risk of floating toe
• 25-40° from long axis of metatarsal
• Parallel to WB surface• Decreases risk of floating toe
4th Annual International External Fixation Symposium
December 11-14, 2008
4
2nd Metatarsal OsteotomySurgical Technique
22ndnd Metatarsal Metatarsal OsteotomyOsteotomySurgical TechniqueSurgical Technique
4th Annual International External Fixation Symposium
December 11-14, 2008
5
2nd Metatarsal OsteotomySurgical Technique
22ndnd Metatarsal Metatarsal OsteotomyOsteotomySurgical TechniqueSurgical Technique
2nd Metatarsal OsteotomySurgical Technique
22ndnd Metatarsal OsteotomyMetatarsal OsteotomySurgical TechniqueSurgical Technique
4th Annual International External Fixation Symposium
December 11-14, 2008
6
2nd Metatarsal OsteotomySurgical Technique
22ndnd Metatarsal OsteotomyMetatarsal OsteotomySurgical TechniqueSurgical Technique
4th Annual International External Fixation Symposium
December 11-14, 2008
7
2nd Metatarsal OsteotomyRevision Case
22ndnd Metatarsal OsteotomyMetatarsal OsteotomyRevision CaseRevision Case
4th Annual International External Fixation Symposium
December 11-14, 2008
8
2nd Metatarsal OsteotomyComplications
22ndnd Metatarsal OsteotomyMetatarsal OsteotomyComplicationsComplications
• MTP joint stiffness
• Transfer metatarsalgia
• Floating toe
• Nonunion/malunion
• Prominent hardware
• Infection
• MTP joint stiffness
• Transfer metatarsalgia
• Floating toe
• Nonunion/malunion
• Prominent hardware
• Infection
2nd Metatarsal Osteotomy (Hansen)2nd Metatarsal Osteotomy (Hansen)
4th Annual International External Fixation Symposium
December 11-14, 2008
9
Multiple MetatarsalsMultiple Metatarsals
4th Annual International External Fixation Symposium
December 11-14, 2008
10
4th Annual International External Fixation Symposium
December 11-14, 2008
11
Brachymetatarsia 2ndBrachymetatarsia 2nd
4th Annual International External Fixation Symposium
December 11-14, 2008
12
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