Lesser metatarsal osteotomy

Dorsiflectory metatarsal osteotomies are performed for the treatment of lesser metatarsalgia, most often for

2nd Metatarsal Surgery

Fig. 8.14 Chronic intractable plantar keratosis beneath the 2nd metatarsal head. The callus has been debrided, revealing preulcerative haemorrhage within the skin. This is an indication for lesser metatarsal osteotomy.

Callus Excised

Fig. 8.13 Sesamoidectomy. (a) Intraoperative photograph, the ulcer has been excised, (b) The hypertrophic tibial (medial) sesamoid has been grasped with a bone clamp and is being removed from the wound.

Fig. 8.12 Lateral radiograph of the left foot, reveals a hypertrophic tibial sesamoid. The ulcer was located beneath the sesamoid.

intractable plantar keratoses (IPKs), when non-surgical methods have failed. These procedures are controversial and are often plagued by postoperative complications such as transfer lesions, non-union or malunion, and floating toes. Infection and screw failure have also been reported. Caution should be exercised when considering these procedures for neuropathic individuals. Metatarsal osteotomy is not advised in the presence of infection or full-thickness ulceration beneath the metatarsal head.

Figure 8.14 illustrates a chronic IPK with preulcerative haemorrhage within the callus and a long 2nd metatarsal. This is an appropriate indication for lesser metatarsal osteotomy. Multiple lesser metatarsal osteotomies have been described to include transverse, oblique and closing wedge procedures. Two of the more popular distal procedures are the vertical chevron metatarsal osteotomy

Fig. 8.14 Chronic intractable plantar keratosis beneath the 2nd metatarsal head. The callus has been debrided, revealing preulcerative haemorrhage within the skin. This is an indication for lesser metatarsal osteotomy.

and the Weil shortening osteotomy. Both procedures require internal fixation.

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