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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

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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



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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



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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



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22ndnd Metatarsal OsteotomyMetatarsal OsteotomySurgical TechniqueSurgical Technique



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22ndnd Metatarsal OsteotomyMetatarsal OsteotomySurgical TechniqueSurgical Technique



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2nd Metatarsal OsteotomyRevision Case

22ndnd Metatarsal OsteotomyMetatarsal OsteotomyRevision CaseRevision Case



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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)



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Multiple MetatarsalsMultiple Metatarsals



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Brachymetatarsia 2ndBrachymetatarsia 2nd



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