Twenty patients (14 women and 6 men) (23 feet) had a single oblique os
teotomy operation of the 2nd, 3rd, or 4th metatarsal without fixation
during an 8-year period. The mean age was 46 years (range, 21-64 years
). Each patient had a painful intractable plantar keratosis preoperati
vely. The average follow-up was 10 years (range, 3-14 years). Postoper
atively, reoperation was performed in four feet because of painful cal
losities. For 13 of the 19 feet that did not have reoperation, patient
s were limited in footwear or required a shoe insert. Overall results
were good for 10 feet, fair for 7 feet, and poor for 6 feet. The only
complication was a deep infection that occurred in one foot (good resu
lt). Nonunion occurred in one foot and delayed union in one. The avera
ge decrease in metatarsal length after osteotomy was 6 +/- 6 mm. The s
ingle oblique lesser metatarsal osteotomy may be successful, but one h
alf of the patients continued to have some degree of pain and most pat
ients had limitations in footwear. Overall results were disappointing,
and patients who are offered this procedure should be advised of its
limitations.