Lui Tun Hing
Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR.
Foot (Edinb). 2014 Dec;24(4):180-5. doi: 10.1016/j.foot.2014.08.008. Epub 2014 Aug 18.
Metatarsalgia can be caused by plantarflexion of a central metatarsal or discrepancies in the metatarsals' length. Nonsurgical management is usually sufficient to achieve satisfactory results. For those recalcitrant cases, metatarsal osteotomy is needed to relieve the pain. We describe a technique of percutaneous dorsal closing wedge osteotomy of the metatarsal to manage the recalcitrant metatarsalgia. A case series was reviewed retrospectively.
From March 2010 to March 2013, percutaneous dorsal closing wedge osteotomy of the metatarsal neck has been performed in 33 patients. Thirty six feet with 63 metatarsals were operated on. Thirty two second metatarsals, 22 third metatarsals, 5 fourth metatarsals and 4 fifth metatarsals were operated on.
All the osteotomy sites healed up without any transverse plane deformity. The painful callosities subsided except in one operated metatarsal. Recurrence of painful callosities occurred in 2 operated metatarsals. Transfer metatarsalgia occurred in 2 feet. Floating toe deformity occurred in 2 operated rays. There was no nerve injury noted. Two patients had delayed wound healing with serous discharge and the wounds were eventually healed up with wound dressing.
Percutaneous dorsal closing wedge osteotomy of the metatarsal neck is an effective and safe surgical treatment of recalcitrant metatarsalgia.
跖痛症可由中央跖骨的跖屈或跖骨长度差异引起。非手术治疗通常足以取得满意效果。对于那些顽固性病例，需要进行跖骨截骨术以缓解疼痛。我们描述一种经皮跖骨背侧闭合楔形截骨术治疗顽固性跖痛症的技术。回顾性分析一组病例。
2010年3月至2013年3月，对33例患者实施了跖骨颈经皮背侧闭合楔形截骨术。共对36足的63根跖骨进行了手术。其中对32根第二跖骨、22根第三跖骨、5根第四跖骨和4根第五跖骨进行了手术。
所有截骨部位均愈合，无任何横向平面畸形。除一根手术跖骨外，疼痛性胼胝均消退。2根手术跖骨出现疼痛性胼胝复发。2足出现转移性跖痛症。2根手术跖骨出现浮趾畸形。未发现神经损伤。2例患者伤口愈合延迟，有浆液性渗出，最终经伤口换药愈合。
跖骨颈经皮背侧闭合楔形截骨术是治疗顽固性跖痛症的一种有效且安全的手术方法。
