Percutaneous Foot Osteotomy

Foot Osteotomy: A Feasible Percutaneous Procedure

Several procedures can be performed using percutaneous techniques:

• Foot osteotomies, which are bone fractures
• Tenotomies, which are tendon sections
• Surgery for hallux valgus or round forefoot
• Surgery (tenotomy, arthrodesis, soft tissue release, or osteotomy) for clawed toes
• Surgery for metatarsalgia (forefoot pain)
• Correction of fifth toe deformity (quintus varus)

Types of Big Toe and Foot Osteotomies

Osteotomy (of the big toe or foot) is a surgical procedure that involves cutting a bone to change its axis, size, or shape. When possible and appropriate for the patient's condition, Dr. Julien Lopez prefers percutaneous osteotomy.

There are several types of percutaneous osteotomies, including:

• Weil osteotomy of the lateral metatarsals
• Chevron osteotomy
• DMMO (Distal Metatarsal Mini-invasive Osteotomy) technique

Percutaneous Weil Osteotomy

Dr. Julien Lopez treats metatarsalgia using percutaneous DMMO-type osteotomy. This technique requires non-dislocated metatarsophalangeal joints; otherwise, the percutaneous technique cannot be performed, and a more extensive open-skin approach will be required to perform Weil-type osteotomies, allowing for greater correction and joint dislocation.

Main Indications

Metatarsalgia is a condition of the forefoot characterized by intense pain in the front of the foot, located at the metatarsal heads and the plantar arch.

The metatarsals are the bones of the foot, each consisting of three parts: the head, body, and base.

During walking, almost the entire body weight is supported by the metatarsal heads. It can happen that one metatarsal is longer than the others, bearing an additional load. This deformation can lead to the formation of plantar calluses and localized pain at the base of the toes. A long metatarsal typically affects the second and sometimes the third metatarsal. This situation can also lead to clawed toe deformity. Another common cause of metatarsalgia is the collapse of the anterior arch of the foot, referred to as a round forefoot (a common cause of mechanical metatarsalgia). The anterior arch of the foot is normally concave but can sometimes become convex, increasing pressure on the forefoot during walking and causing pain.

Metatarsalgia primarily affects women due to wearing narrow and tight shoes or high heels.

To make the diagnosis, the surgeon performs a clinical examination and conducts medical imaging tests to visualize deformations and how body weight is distributed on the forefoot.

In case of failure of conservative treatment, Dr. Julien Lopez may consider surgical treatment such as percutaneous osteotomies of the lateral rays. The goal of the intervention is to reduce pain by modifying bone support on the ground.

Surgery of the Foot by Osteotomy: The DMMO (Distal Metatarsal Mini-invasive Osteotomy) Technique

This foot surgery by osteotomy is also used to treat metatarsalgia. It involves breaking the affected metatarsal and those surrounding it. They are then allowed to naturally fuse by bearing weight on the foot after the operation. The DMMO percutaneous metatarsal osteotomy is a non-invasive method.

Percutaneous lateral ray osteotomy aims to shorten an excessively long metatarsal. This procedure is performed percutaneously through 2 mm mini-incisions. The surgeon uses small instruments for this purpose. The percutaneous technique allows the surgeon to perform the surgical procedure without the need to open the skin and joints. The size of the scar in the case of toe osteotomy is generally smaller than that generated by conventional "open" surgery.

DMMO-type osteotomy is performed through an incision located on the lateral side of the metatarsal head. Dr. Julien Lopez then releases the soft tissues with a thin instrument to prepare the working space. A motorized percutaneous drill is used to cut the neck of the metatarsal head at an oblique angle. This action is intended to move the bone a few millimeters towards the heel. Once these steps are completed, the surgeon does not need to fix the fractures because percutaneous fractures of the metatarsal heads are not stabilized. Fracture adjustment occurs during walking with weight-bearing and according to tendon and ligament tensions.

If the patient has multiple deformities, other surgical procedures may be performed during the intervention.

Treatment of Hallux Valgus by Chevron Osteotomy

Indications

Treatment of hallux valgus bychevron osteotomy is performed in cases of mild to moderate deformities.

Hallux valgus, commonly known as a "bunion," is a deviation of the big toe toward the outside. This progressive deviation creates a visible dorsal bump.

Hallux valgus is the most common deformity of the forefoot. This deformity is both aesthetically displeasing and painful.

Dr. Julien Lopez specializes in the percutaneous treatment of hallux valgus. Please feel free to consult the dedicated page for this condition in the "Pathologies" section.

Procedure

The chevron osteotomy has the advantage of requiring a short skin incision (about 20 mm). It can be considered a minimally invasive hallux valgus osteotomy.

The objective of the intervention is to reduce the angle between the first and second metatarsals. During minimally invasive foot surgery, Dr. Julien Lopez performs a V-shaped cut in the distal part of the first metatarsal near the metatarsal head. This allows for the lateral translation of the distal part of the bone by a few millimeters. The bone is then fixed with one or two oblique screws. Any excess bone is subsequently removed.

The time to resume activities and the length of work leave after foot osteotomy will vary depending on the technique used by the surgeon. If you have any questions, please do not hesitate to contact Dr. Julien Lopez's office by phone or email using the contact form.

The informations on the page is provided for information only, it evokes general cases: your situation is specific.

Dr Julien Lopez, orthopedic foot surgeon in Nice welcomes you and advises you for your plantar aproneuritis.

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