Metatarsal neck osteotomy with rigid internal fixation for the treatment of lesser toe metatarsophalangeal joint pathology

Metatarsalgia associated with metatarsophalangeal (MTP) joint instability a nd/or plantar callosity formation is a difficult problem to treat. During a 15-month period, we performed 50 osteotomies of the metatarsal neck with r igid internal fixation in 47 feet of 42 patients. Three patients were exclu ded from the study, leaving 47 osteotomies in 44 feet of 39 patients for re view. There were 6 men and 33 women, with a mean age of 57 years. In additi on to lesser MTP joint pain with or without instability, the majority of pa tients had first ray pathologic condition, which was also addressed at the time of surgery. All but one of the osteotomies were united radiologically at 6 weeks. The mean shortening was 4.1 mm (range, 2-12 mm), and the mean f ollow-up was 9 months. There were no cases of malunion, nonunion, or avascu lar necrosis. At follow-up, 33 patients were asymptomatic. Eight patients ( nine feet) had a degree of persisting pain at follow-up (seven mild and two moderate), but the source of this pain was only the metatarsal or MTP join t that was operated on in three cases. In this article, we describe the ind ications, the technique, and the results of the osteotomy.