Percutaneous Approaches to Distal Metatarsal Osteotomies (DMOs) for the most common Forefoot Diseases

Abstract

[eng] INTRODUCTION: Minimally Invasive Surgery (MIS) became popular among surgeons from the end of the last century, and a fundamental step in the development of this surgical treatment was the foundation of GRECMIP (Groupe de Recherche et d' Enseignement en Chirurgie Mini-Invasive du Pied) in 2002. This group, incorporated soon in the international Minimally Invasive Foot & Ankle Society (MIFAS), improves and promotes MIS of the foot and ankle by organising annual courses worldwide. This surgical approach is characterised by minimal access, generally smaller than 3.5 cm, that allows 1-day surgery hospitalisation and several benefit for patients: less pain, decrease of post- operative complications and lower recovery and rehabilitation times. HYPOTHESIS: minimally invasive DMO, performed at different levels of the distal part of metatarsal bones MBs (1st-5th), as a single or an associate procedure, with or without fixation, (temporary by Kirschner Wises (KWs) or permanent by MIIND, may be an effective surgical treatment option for achieving metatarsalgia symptom resolution, healing of Plantar Diabetic Foot Ulcers (PDFUs) and Hallux Valgus (HV) correction. Objectives: the aims of this thesis in compendium of publications format were to: 1. prospectively evaluate the clinical and radiographic outcomes of patients complaining of the most common forefoot diseases, treated by each of the following 4 DMOs by MI or percutaneous approaches: - Distal Metatarsal Metaphyseal Osteotomy (DMMO) for persistent central primary metatarsalgia, associated or not to HV and lesser toe deformities; - Minimally Invasive Metatarsal Osteotomies (MIMOS), considering only the Distal Metatarsal Osteotomies (DMOs), such as the Distal Metatarsal Diaphyseal Osteotomies (DMDO) for CPDFUs; - Reverdin-Isham (RIO) in combination with Akin Percutaneous Osteotomy (APO) and Lateral Soft-Tissue Release (LSTR) for correction of mild-to-severe HV; 2. Clarifying and describing their proper indications to guide orthopaedic surgeons in the choice of procedure according to the type and severity of the foot pathology to treat: - metatarsalgia by DMMO [1]; - CPDFUs [2, 3] by MIMOs, including only the distal ones, such as: DMDO [4]; - mild to moderate HV by RIO in combination with APO and LSTR [5]; - severe HV by MIIND [6].