Minimally invasive distal metaphyseal metatarsal osteotomy (DMMO) for symptomatic forefoot pathology - Short to medium term outcomes from a retrospective case series
K. Malhotra, N. Joji, B. Rudge
Introduction: Distal metaphyseal metatarsal osteotomy (DMMO) may be used to treat metatarsalgia and other forefoot pathology by shortening the lesser metatarsals and reducing plantar pressures. It may be performed percutaneously, but there are few large series reporting its results. We report the radiographic and clinical results of a cohort of patients treated with percutaneous DMMOs at our unit.
Methods: This was a single-centre retrospective study looking at the outcome of consecutive patients undergoing percutaneous DMMOs over a 52-month period at our District General Hospital. We analysed demographics, radiological and clinical outcomes, complications and patient reported outcome measures.
Results: We included DMMOs on 106 toes in 43 feet. The mean age of patients was 60.2 ±10.2 years and 41 patients were female (95.3%). The median duration of follow-up was 38 months. The indication was metatarsalgia in 31 patients (72.1%) and MTPJ subluxation in 12 patients (27.9%). Concurrent procedures were performed in 26 cases (60.5%). DMMO was performed on multiple toes in 42 cases (96.7%). Mean shortening achieved was 3.6 ±2.2 mm, 4.1 ±1.6 mm, and 3.6 ±1.6 mm for the 2nd, 3rd and 4th toes respectively. Mean time to fusion was 11.4 ±7.8 weeks and union occurred in 105 toes (99.1%). The single non-union was asymptomatic at 12 months. Two patients (4.7%) required a subsequent additional DMMO for transfer metatarsalgia. Overall, minor complications were seen in 14 patients (31.1%). At final follow-up the mean MOxFQ was 28.8 ±27.6, the mean EQ-5D was 0.789 ±0.225, the mean EQ-VAS was 68.5 ±20.3, the mean VAS-Pain was 3.1 ±2.8, and 41 patients (95.3%) were satisfied overall.
Conclusions: We have demonstrated excellent radiological and clinical outcomes, with relatively few complications in the short to medium term with percutaneous DMMOs.
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