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Shortening effect influence of Distal Minimally Invasive Metatarsal Osteotomy in primary metatarsalgia

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Abstract

Purpose

In primary metatarsalgia, Distal Minimally invasive Metatarsal Osteotomy (DMMO) achieves a correct load distribution which is a factor in pain relief, but contrary to the elevation of the metatarsal head, shortening the metatarsal length has no influence on plantar-loading parameters, while the increased metatarsal length is a factor in the development of metatarsalgia. Thus, we hypothesized that metatarsalgia could be partly related to a functional imbalance between bone structure and soft tissues and pain relief after DMMO results from soft tissue relaxation.

Methods

Many authors have highlighted the correlation between joint pressure and periarticular soft tissue tension. To test our hypothesis, we measured intra-operatively the MTPJ pressure of 19 patients suffering from primary metatarsalgia, before and after DMMO. This pressure is being analyzed as a reflection of joint decompression and forefoot soft tissue release. Many authors have highlighted the correlation between joint pressure and periarticular soft tissue tension.

Results

Lower metatarsals presenting metatarsalgia show a significantly lower MTPJ pressure compared to asymptomatic rays, and DMMO induces a significant increase of MTPJ pressure.

Conclusion

Those variations reflect the functional imbalance between bone structure and soft tissue in primary metatarsalgia. The biomechanical rationale of the shortening effect of DMMO could therefore be explained by the release of forefoot soft tissue, which could take part in the pain relief by restoring this balance.

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Data availability

The data that support the findings of this study are available from the corresponding author, YS, upon reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Orthopaedics, Ambroise Paré Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France

    Simon Tournemine & Thomas Bauer

  2. Department of Orthopaedics, Raymond Poincaré Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 104 Boulevard Raymond Poincaré, 92380, Garches, France

    Fabien Calé & Yves Stiglitz

  3. Clinique Victor Hugo, 5 rue du Dôme, 75116, Paris, France

    Cyrille Cazeau & Yves Stiglitz

  4. 1 Parvis de Notre Dame, Hôtel Dieu Hospital, 75001, Paris, France

    Cyrille Cazeau

Authors
  1. Simon Tournemine
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  2. Fabien Calé
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  3. Cyrille Cazeau
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  4. Thomas Bauer
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  5. Yves Stiglitz
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Corresponding author

Correspondence to Yves Stiglitz.

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Clinical Research Ethics Committee Vivalto Santé, International Review Board approval N° CERC-VS-2020–11-2.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Tournemine, S., Calé, F., Cazeau, C. et al. Shortening effect influence of Distal Minimally Invasive Metatarsal Osteotomy in primary metatarsalgia. International Orthopaedics (SICOT) 46, 983–988 (2022). https://doi.org/10.1007/s00264-021-05146-7

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