Distal Metatarsal Minimally Invasive Osteotomy (DMMO): Surgical technique, variants, indications, and treatment decision-tree

Abstract

Background: Metatarsal osteotomy is a major means of treating mechanical metatarsalgia. Open techniques are widely used, and notably that described by Weil. They have, however, certain drawbacks, and new types of osteotomy have been developed. Percutaneous techniques are presently very much in favor, and Distal Metatarsal Minimally Invasive Osteotomy (DMMO) has emerged as a treatment for metatarsalgia. Although very widely used, it is poorly codified in the literature.

Method: The present study detailed DMMO techniques and their variants (oblique and reverse), with corresponding indications and treatment decision-tree.

Results: Initial findings seem encouraging, with functional results comparable to those of open surgery. Postoperative edema and radiologic bone healing time seem to be longer in DMMO. There is, on the other hand, no difference regarding stiffness.

Conclusion: DMMO is an effective option to treat metatarsalgia, with variants enabling adaptation to foot morphology, but needing confirmation by studies with higher levels of evidence.

Keywords: DMMO; Distal Metatarsal Minimally Invasive Osteotomy; Metatarsalgia; Oblique DMMO; Percutaneous surgery; Reverse DMMO.