- The document discusses a study on percutaneous metatarsal osteotomies for treating metatarsalgia. 67 feet underwent distal to proximal osteotomies under 45 degrees. - Pre- and post-operation pedographic measurements found maximum pressure at M2 decreased on average from 969 kPA pre-op to 652 kPA post-op in 60 feet, with no decrease in 7 feet. - Clinical examination 1 year later found most feet had spontaneous floor contact of P2-P4 and no reported metatarsalgia, though some feet had sensory disturbance or incomplete healing visible.

1. C. Kinast , M. Olos, A.Namazi Pedographic and clinical results of percutaneous metatarsal osteotomies for metatarsalgia

2. Surgical technique : Percutaneous metatarsal osteotomies PCMO 67 feet form dorsal distal to plantar proximal with a steep angle as possible < 45° same surgery: open hallux valgus reconstruction L-Austin ( Bevel ), Akin 52 feet Lapidus Akin 8 feet Other previous surgery 1st ray 7 feet M 2 3 OT n=12 feet M2 3 4 OT n=50 feet M3,4 n=1 feet M2 n=4 feet percutanous hammertoe correction ( dePrado ) n = 42 open PIP arthrodesis KW fixation 4 weeks n = 15 Prospectiv study design: patients with metatarsalgia, with and without hammertoes index minus elevated pedographic pressure of M 2 ( novel emed ) No plantar plate rupture No osteochondral lesions of MPJ 2 3 4 No clinical Morton´s syndrom

3. 2009-F.B. M1 P 1 osteotomy Lactosorb fixation pc MOT 2 3; pc hammertoe correction M 5

4. pre pre post 1 year post 1 year

5. pedography: novel emed M2 P (pressure ) max kPA pre-post-difference M2 post less than als pre n=60 feet -403 kPa M2 all n=67 feet -313 kPa M2 post more than preop n=7 feet +262 kPa M 3 P max > M 2 P max n = 8 feet transfer-overload No clinical transfer metatarsalgia !!! so far P max M2 average preop 969 kPA post op 652 kPA Dynamic pedobarography was performed using the EMED-SF1 pressure platform (Novel GmbH, Munich, Germany) with a spatial resolution of four sensors per cm2. Measurements at 50-Hz sample frequency were used to obtain barefoot plantar pressures. Each subject was tested using the two-step method in which platform contact was made on the second step after initiation of gait

6. Clinical examination: 1 year minimum follow up metatarsalgia: none sensory disturbance : 5 feet at 1 year P 2 spontanous floor contact 61 feet P2 floor contact with active plantarflexion x-ray: healing without significant callus 24 feet healing with severe callus 41 feet incomplete healing visible osteotomy gap after 1 year 2

7. Summary: percutaneous osteotomies M 2 3 4 Pedography max pressure was decreased from P max M2 average preop 969 kPA post op 652 kPA in 60 feet 7 feet no decrease floorcontact of Z2 3 4 was positive in most of the feet subcapital osteotomies heal faster as more proximal osteotomies Metatarsalgia was successfully treated