MIS distal metatarsal metaphyseal osteotomy in the treatment of metatarsalgia: MOXFQ patient reported outcomes

W. McMurrich, D. MacDonald, A. Peters, H. Shalaby, J. McKinley, G. Baer, M. Ellis

Aim: The aim of this paper is to present validated patient reported outcomes for MIS Distal Metatarsal Metaphyseal Osteotomy (DMMO) in the treatment of metatarsalgia. We aim to evaluate the DMMO procedure, report patient satisfaction with the operated foot and report any complications of this procedure.

Patients and methods: Between 2014 and 2016, patients who had failed conservative treatment for metatarsalgia were identified in the orthopaedic outpatient clinic. 24 consecutive patients requiring DMMO plus/minus toe straightening were prospectively studied. Patients requiring additional procedures at the time of surgery were excluded. Patients completed the validated Manchester-Oxford Foot Questionnaire (MOXFQ) three weeks pre-operatively and 1 year post-operatively. The MOXFQ results were analysed using paired t-tests. A supplementary question was asked regarding patient satisfaction with the operated foot.

Results: There were 20 women and 4 men with a mean age at the time of surgery of 64 years (sd 8.6). Statistically significant differences were found between the pre and post-operative MOXFQ. The post operative MOXFQ score demonstrated a poorer result for two patients, no change for two patients and improvement in 20 patients, with four of these patients recording the lowest possible score. There was a 29.5 point improvement in mean metric MOXFQ Index score. 79% (n=19) of patients were satisfied or very satisfied with the operated foot. The reported post operative complications experienced were a gastric bleed, pulmonary embolism (VTE), two delayed union, and one broken burr occurring intra operatively.

Conclusion: Our study demonstrates a statistically significant and clinically important improvement in patient reported outcomes following DMMO and good to excellent satisfaction with the procedure. We report two patients with delayed union and no non-unions which is comparable to other lesser metatarsal osteotomy procedures.