I respectfully disagree with Gino Scartozzi, DPM
on many of his points regarding the obligation
to fixate lesser metatarsals. I do respect his
experience and do not disregard all of what he
says. However, what does the literature say.
Let’s take a look at recent literature. Thomas
Bauer, MD (West Paris University) performed a
recent study on distal metatarsal mini-invasive
osteotomies (DMMO). He performed 118 non-fixated
DMMO cases of metatarsalgia with a mean follow-
up of 26 months. IPKs and metatarsalgia
disappeared on average in 2.5 months in all
cases. AOFAS forefoot score significantly
improved from a mean of 60/100 pre-operatively
to 94/100 post-operatively. Only 2 patients had
marked stiffness in mpj ROM and both these were
intrarticular placements.
The breakdown was as follows: in 4 patients,
DMMO’s were performed on the 2nd and 3rd rays
only. On all other cases, the 2nd, 3rd, and 4th
rays were done simultaneously. Transfer lesions
only occurred in a case in which only the 2nd
and 3rd ray were performed. No transfer lesions
were seen in the cases where the 2nd3rd and 4th
metatarsals had non-fixated DMMO. Only 1 non-
union was seen and the patient was asymptomatic
after 4 years. Minimally Invasive Surgery of the
Foot and Ankle 2011, page 157.
In the right hands, MIS on lesser metatarsal
(non-fixated DMMOs) can yield superior results
for the treatment of metatarsalgia. If a surgeon
does not want to perform MIS, that’s fine.
Traditional surgery is noble indeed. I choose to
have both MIS and traditional surgery in my
arsenal and my patients have greatly benefited .
Don Peacock, DPM, Whiteville, NC, Don Peacock,
DPM
