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["Chevron" basal osteotomy of the middle metatarsal bones for static metatarsalgia. Apropos of 69 cases].

PURPOSE OF THE STUDY
Round or flat forefoot metatarsalgia are frequent and surgical techniques are various. The authors relate a series with chevron basi-metatarsal osteotomy.


MATERIAL
69 operated metatarsalgia were reviewed at a mean follow up of 5 years.


METHODS
The surgical approach was dorsal, aligned on metatarsal diaphysis. The basi metatarsal "chevron shape" osteotomy was performed using an oscillatory saw, on 1, 2 or 3 metatarsi inducing lowering and shortening. This osteotomy wasn't fixed. Weight bearing was allowed at the third post-operative day.


RESULTS
In 68 per cent of cases, the global result was good or very good, but it persisted 32 per cent of post-operative pain either climatic or continuous, including 29 per cent metatarsalgia. The plantar corns only disappeared one out of twice, but the shoe wearing was improved in 82.6 per cent of cases.


DISCUSSION
This study showed that the results improved when 3 median metatarsal osteotomy were performed simultaneously. The forefoot morphology didn't influenced the final result. In fact, this technique includes a good result one out of twice in hollow feet. It seems that three metatarsal osteotomies induce a metatarsal elevation and shortening, once out of twice.


CONCLUSION
The advantage of this technique are : a dorsal medio plantar surgical approach, an osteotomy realized in cancellous bone and no need for fixation allowing a more accurate adjustment of the metatarsal height.