Retrospective Review of Distal Minimally Invasive Metatarsal Osteotomies Performed over a 10-year Period: A Case Series

Background: Distal metaphyseal metatarsal osteotomies (DMMO) is an effective surgical technique for treating forefoot pathology. This study presents clinical and radiological outcomes over a 10-year period, representing one of the largest reviews of DMMO. Materials and methods: A retrospective, single-center, single-surgeon study was conducted, analyzing consecutive patients undergoing DMMO. Demographic data, clinical and radiological outcomes, and complications were reviewed. Additionally, complex cases were selected to illustrate the versatility of DMMO. Results: A total of 385 toes in 106 feet were treated. The mean patient age was 57 years, with a female-to-male ratio of 4.5:1. DMMO was performed for primary transfer metatarsalgia (54 feet), metatarsalgia following first-ray surgery (20 patients), claw toe correction with metatarsophalangeal joint (MTPJ) subluxation (13 patients), bunionette correction (13 patients), metatarsus adductus correction (5 patients), and pes cavus (1 patient). Overall, 84% of patients reported excellent outcomes, with only one poor outcome. No nonunions were identified. One patient required revision DMMO due to persistent transfer metatarsalgia. Conclusion: This study demonstrates excellent medium- to long-term clinical and radiological outcomes with DMMO. We demonstrated the versatility of this technique through three challenging cases: iatrogenic first-ray shortening, persistent metatarsalgia post-Weil osteotomy, and metatarsus adductus.