Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for primary central metatarsalgia

Objective is to investigate the potential of DMMO to restore a harmonious forefoot morphotype according to Maestro criteria. Retrospective study investigated 51 feet in 48 patients with central primary metatarsalgia between the 2nd and 4th metatarsal. Associated procedures included hallux valgus and lesser toe corrections. Patients were evaluated radiographically with comparison of their forefoot morphotypes after the DMMO procedure to their preoperative state regarding the Maestro criteria. A subgroup of 17 patients was evaluated for union in 3 months and functionally by the AOFAS and VAS scale. Ten percent of the 48 patients were male and ninety percent were female with a mean age of 52.1 ± 11.7 (range 23 to 70) years. In total 148 DMMOs were performed in 51 feet. Osteotomies were localized on M2 and M3 in 10% and on three metatarsals (M2-M3-M4) in 90%). In 84% associated procedures were performed. All radiographic parameters of the Maestro criteria were significantly different preoperative compared to postoperative (p<0.05). In 94% patients of the subgroup there was a bony consolidation at three months. There was a mean AOFAS-score of 76.8 ± 15.1 (range 49-95) and a mean VAS-score of 2.7 ± 1.7 (range 1-6). There were late complications in 8% of the patients. DMMO is effective for treating primary central metatarsalgia unless the ideal harmonious forefoot was not restored. For DMMO the Maestro criteria have no predictive value for clinical outcome in preoperative planning. Further studies are necessary to correlate the functional improvement. Level of evidence: Level IV retrospective case series.