Devos Bevernage B, Leemrijse Thibaut
Department of Orthopaedic Surgery, Cliniques Universitaires St-Luc, B1200 Bruxelles, Belgium.
Foot Ankle Int. 2008 Feb;29(2):142-9. doi: 10.3113/FAI.2008.0142.
The use of metatarsal osteotomies in the treatment of metatarsalgia is controversial, as is the best location of the osteotomies to prevent transfer metatarsalgia. To determine if metatarsal osteotomies used in forefoot reconstruction to restore the normal anatomical curve would decrease the risk of transfer metatarsalgia, the clinical outcomes of such osteotomies were correlated with the preoperative planning.
Between 2000 and 2005, 63 patients (73 feet) with persistent metatarsalgia had forefoot reconstructions that included one or more Weil osteotomies designed to restore the theoretically ideal foot morphotype described by Maestro et al. and based on the relative lengths of the lesser rays.
The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score of 36.2 improved to 82.2 postoperatively. Sixty-two (85%) of the 73 feet were pain-free after surgery.
In spite of careful preoperative planning, it was difficult to obtain the ideal foot type, and the frequency of transfer metatarsalgia in our patients was similar to that reported in the literature. A significant (p = 0.03) relationship was identified between the amount of preoperative instability and the risk of developing transfer metatarsalgia. Preoperative dorsoplantar standing radiographs, although helpful in planning surgery to obtain appropriate metatarsal lengths, should not be the only method used for operative planning.
跖骨截骨术在治疗跖痛症中的应用存在争议，截骨术预防转移性跖痛症的最佳位置也存在争议。为了确定在前足重建中使用跖骨截骨术以恢复正常解剖曲线是否会降低转移性跖痛症的风险，将此类截骨术的临床结果与术前规划进行了关联分析。
2000年至2005年间，63例（73足）持续性跖痛症患者接受了前足重建手术，其中包括一项或多项Weil截骨术，旨在恢复Maestro等人描述的理论上理想的足部形态类型，并基于较小跖骨的相对长度。
术前美国矫形足踝协会（AOFAS）平均评分为36.2分，术后提高到82.2分。73足中有62足（85%）术后无痛。
尽管进行了仔细的术前规划，但仍难以获得理想的足部类型，我们患者中转移性跖痛症的发生率与文献报道相似。术前不稳定程度与发生转移性跖痛症的风险之间存在显著（p = 0.03）相关性。术前背侧-跖侧站立位X线片虽然有助于规划手术以获得合适的跖骨长度，但不应是手术规划的唯一方法。
