Incidence and Functional Impact of Floating Toe after Distal Metatarsal Minimal Invasive Osteotomy Compared to Open Modified Weil Osteotomy

Category: Lesser Toes; Hindfoot Introduction/Purpose: Distal metatarsal osteotomies for metatarsalgia are one of the most frequent procedures in foot and ankle surgery, however, sometimes their results are not so favorable, with sequelae such as floating toe or loss of toe grip. The open modified Weil osteotomy (OWO) is considered the first alternative in metatarsalgia cases for many surgeons, nevertheless, in recent years, minimally invasive surgery (MIS) has become an attractive alternative for the management of this pathology. To date, there is scarce literature that compares clinical and functional results between both techniques. The objective of this study is to compare the clinical and functional outcomes between OWO and minimally invasive distal metatarsal osteotomy (DMMO), with and without lesser toe procedures. Methods: We performed a retrospective review of 77 patients who underwent OWO or DMMO, with at least 12 month follow up. We excluded patients with incomplete data, previous forefoot surgery, and patients with neuromuscular or rheumatological diseases. Our main outcome was to evaluate the presence of floating toe. Our secondary outcomes were to evaluate toe grip strength (paper pullout test), functional scores (LEFS and AOFAS) and satisfaction. All patients were clinically evaluated by one foot and ankle surgeon who did not participate in any of the surgical procedures. Statistical analysis was performed using Student's t-test, Fisher's test, and Chi-square. Results: 77 patients (188 rays) were included. 120 rays received OWO, and 68 rays DMMO. 95% women, with a mean age of 57 years. The mean follow-up was 39.4 months. The floating toe incidence was 56.7% in the OWO group (67.3% when a DuVries procedure was added), which was significantly higher (p=0.001) than the 25% in the DMMO group (37.9% when P1 MIS osteotomy was added). When comparing lesser toe grip strength between both groups, the DMMO patients had significantly greater grip strength (p=001) Significant differences were obtained between both groups when comparing satisfaction (p=0.04), LEFS (p=0.001), and AOFAS scores (p=0.001), being better in the DMMO group. Conclusion: In our series, the DMMO procedure had significantly lower incidence of floating toe, greater toe grip strength, better functional outcomes and superior satisfaction scores than the OWO. When a bone procedure in the lesser toe is added (MIS osteotomy or DuVries) the floating toe incidence is increased, but not with statistical significance.