Metatarsal Osteotomy (DMMO) in Hauts-de-Seine
Foot Surgery
What is a metatarsal osteotomy?
Dr Simon Tournemine in Hauts-de-Seine (92)
The forefoot is composed of five metatarsal bones, which articulate with the toe phalanges. The heads of these metatarsals form the primary weight-bearing area of the forefoot during standing and walking.
In certain foot disorders, the normal distribution of pressure across the forefoot becomes disrupted. Metatarsalgia refers to pain beneath the ball of the foot caused by excessive loading of one or more metatarsal heads during walking or prolonged standing. As pressure increases, calluses (areas of thickened skin) may develop beneath the affected region.
Metatarsal osteotomy
Specialist in Foot Surgery in Hauts-de-Seine (92)
The objective of surgery is to restore balanced weight distribution across the forefoot by correcting the underlying deformity. Realigning the metatarsal heads reduces abnormal pressure beneath the foot and relieves painful overload.
The procedure is performed using a minimally invasive percutaneous technique under fluoroscopic (X-ray) guidance. A 3 mm skin incision is made over each metatarsal requiring correction.
The affected metatarsal is then carefully divided (osteotomy), slightly shortened and elevated in order to reduce excessive plantar loading. No internal fixation hardware is required.
The operation typically takes around 20 minutes.
Surgery is performed under either general anaesthesia or regional anaesthesia (where only the leg is anaesthetised). The most appropriate anaesthetic technique will be determined during your preoperative consultation with the anaesthetist.
The procedure is carried out as day-case (outpatient) surgery, allowing you to return home on the same day.
Except in exceptional circumstances, both feet are not operated on simultaneously. An interval of approximately one month between procedures is generally recommended.
Metatarsal Osteotomy in Rueil-Malmaison
Foot Surgery in Hauts-de-Seine
When should a metatarsal osteotomy be performed?
Treatment always begins with conservative management.
This typically combines appropriate footwear, custom orthotic insoles, weight reduction where appropriate, and regular podiatric care.
When these measures no longer provide adequate relief and daily pain becomes disabling, surgical treatment may be recommended. The procedure restores a more even distribution of pressure across the forefoot, thereby relieving pain associated with excessive loading.
Postoperative care and rehabilitation following metatarsal osteotomy
The procedure is performed as day-case surgery, and patients usually return home on the day of the operation.
A sterile dressing is applied in the operating theatre and must remain in place for two weeks without being removed.
Pain management is carefully monitored to maximise comfort and facilitate early recovery.
Anticoagulant treatment is prescribed for two weeks to reduce the risk of deep vein thrombosis.
Walking is permitted immediately while wearing a PODONOV forefoot offloading shoe, which should be worn for approximately six weeks.
Swelling (oedema) of the foot and toes is expected following surgery and forms part of the normal healing process. Resting regularly and elevating the foot will help reduce postoperative swelling more rapidly.
Physiotherapy should begin early to maintain toe mobility and optimise functional recovery.
Most patients require approximately three weeks away from work, although this depends on the nature of their occupation. Patients with sedentary office-based work may often return sooner.
Sporting activities are generally resumed after approximately three months.
These recovery times are average estimates and may vary according to individual healing.
Long-term clinical and radiographic follow-up is recommended to monitor healing and identify any potential complications.
Risks and complications of metatarsal osteotomy
Every precaution is taken to optimise healing and minimise complications. Nevertheless, as with any surgical procedure, certain risks remain, although they are uncommon:
- deep vein thrombosis (DVT) and pulmonary embolism, with the risk reduced through anticoagulant treatment for two weeks following surgery;
- worsening of pre-existing medical conditions, such as heart failure or diabetes, with appropriate postoperative monitoring provided by the anaesthetic team;
- infection (risk below 1%). Should infection occur, additional surgery to clean the operative site together with antibiotic treatment may be required;
- postoperative stiffness and reduced toe mobility if rehabilitation is not adequately performed;
- haematoma resulting from postoperative bleeding;
- injury to small sensory nerve branches supplying the foot, potentially resulting in areas of reduced sensation affecting one or more toes.
Complex Regional Pain Syndrome (CRPS) is a painful inflammatory condition that remains poorly understood. It is treated medically and may persist for several months, or occasionally several years, requiring specialised rehabilitation, additional investigations and, in some cases, dedicated pain management. Both its occurrence and long-term evolution remain unpredictable.
These represent the principal potential complications, although this list is not exhaustive. Rare and exceptional complications may also occur. Not every possible complication can be anticipated in advance. Your surgeon will discuss your individual case and answer any questions during your consultation.
Results of metatarsal osteotomy
Without treatment, metatarsalgia generally progresses, with increasing plantar overload and worsening pain.
The procedure restores a more balanced distribution of pressure across the forefoot. By eliminating areas of excessive loading, pain is significantly relieved while preserving normal foot function.
Walking and sporting activities are not restricted following recovery.
Approximately 90% of patients experience significant improvement in pain after surgery.