Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Learning Curve. Issue 3 (June 2018)

• Record Type: Journal Article
• Authors: Krenn, Sabine; Albers, Sascha; Bock, Peter; Mansfield, Clemens; Chraim, Michel; Trnka, Hans-Joerg
• Is Part Of: Foot & ankle specialist. Volume 11:Issue 3(2018)
• Page Start: 263
• Page End: 268
• Publication Date: 2018-06
• Subjects: minimally invasive surgery -- DMMO -- Weil osteotomy -- learning curve -- pedobarography; Podiatry -- Periodicals; Orthopedics -- Periodicals; Foot -- Diseases -- Periodicals; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; 617.585
• DOI: 10.1177/1938640017750251
• Languages: English
• ISSNs: 1938-6400

Abstract

Background . Minimally invasive surgery has a shorter surgical time, and in this study we focus on minimally invasive distal metatarsal metaphyseal osteotomy (DMMO). The operation seems to be less complex but requires a high learning curve. We report on our first patients to underline the need for extensive training and great awareness for the risks in the early learning stages. Methods . We evaluated 27 patients (mean age = 60.9 years) with a mean follow-up time of 7.2 months. Indication was metatarsalgia, intractable plantar keratosis, and the (sub-)luxation of the metatarsophalangeal joint. Clinical results were evaluated with the 12-item Short Form (SF-12), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM), and the American Orthopaedic Foot and Ankle Score (AOFAS). Radiographs and pedobarographic analysis were obtained. Results . Scores ranged closely to standard value (AOFAS 88.07 points; FFI 93%; FAAM 36.4 points; SF-12 31.27 points). Pedobarography showed significant differences in several forefoot areas. We encountered nonunion/malunion and necrosis of the metatarsal head. Conclusions . The aim of this study was to demonstrate the need for intensive training before practicing DMMO. Results show that minimally invasive DMMO requires a high learning curve. Correct handling of the burr is associated with a lot of training. Wrong handling can lead to nonunion/malunion or necrosis. Levels of Evidence: Therapeutic, Level IV: Case series