Minimally Invasive Metatarsal Osteotomy (DMMO): A Modern Solution for Foot Pain

Indications for Minimally Invasive Metatarsal Osteotomy (DMMO)

Minimally invasive metatarsal osteotomy (DMMO) is indicated for patients suffering from a variety of forefoot conditions that cause significant pain and functional impairment. This procedure is particularly beneficial for those with metatarsalgia, characterized by pain and inflammation in the ball of the foot, and for patients with hammertoes, where one or more toes are abnormally bent at the middle joint. Patients who have failed to find relief with conservative treatments, such as orthotics, physical therapy, and pain management, are prime candidates for this surgical intervention. DMMO is also suitable for individuals seeking a less invasive surgical option that minimizes recovery time and reduces postoperative complications compared to traditional open surgeries.

The Procedure

The DMMO procedure involves a small incision, typically less than 1 cm, to access the metatarsal bones of the foot. We typically make precise cuts in the distal (end) part of one or more metatarsal bones (long bones of the foot). These cuts allow for realignment and redistribution of pressure across the foot, alleviating pain and correcting deformities such as metatarsalgia, recurrent calluses, and hammertoes.

The key advantages of this minimally invasive technique include:

• Reduced Incision Size: The tiny incision reduces tissue trauma, leading to less pain and swelling postoperatively.
• No Hardware Needed: Unlike traditional surgeries that may require screws or plates, DMMO relies on the natural healing process of the bone, which simplifies the procedure and avoids potential complications associated with hardware.
• Precision and Control: The surgeon can make very precise adjustments to the bones, ensuring optimal correction and alignment.
• Immediate weight bearing: Patients are asked to immediated bear weight on the surgical foot in a protective boot whic is subsequently replaced with a regular shoe in 2-3 weeks after the surgery. 

Postoperative Recovery

Recovery from DMMO is generally swift, with patients able to bear weight and walk shortly after the procedure. Here's a typical timeline for recovery:

0-2 Weeks: Protected Walking with Medical Boot

• Immediately After Surgery: A medical boot is provided to protect the foot and support initial healing.
• Full Weight-Bearing: Patients are encouraged to walk with the boot, which helps to maintain mobility and prevent stiffness.
• Activity Level: Daily activities can be resumed, but high-impact or strenuous activities should be avoided to protect the surgical site.

2-6 Weeks: Transition to Supportive Tennis or Walking Shoes

• Week 2: The medical boot is replaced with supportive tennis or walking shoes, which provide comfort and continued support.
• Continued Weight-Bearing: Patients continue walking in supportive footwear, gradually increasing activity levels as comfort allows.
• Activity Level: Patients should focus on activities that do not cause pain or discomfort, gradually reintroducing more strenuous activities as tolerated.

6+ Weeks: Regular Shoe Gear as Tolerated

• Week 6: Transition to regular shoe gear as tolerated, prioritizing footwear that offers good support and fits comfortably.
• Full Activity Resumption: Patients can resume normal activities, paying attention to their body's signals and avoiding actions that cause pain.
• Follow-Up Care: Regular follow-up appointments with the surgeon ensure proper healing and address any concerns.

Risks and Considerations

While DMMO is a minimally invasive and highly effective procedure, it is not without risks. Potential complications include:

• Infection: Rare but possible, managed with appropriate wound care and antibiotics if necessary.
• Delayed Healing: Bones may take longer to heal in some cases, especially if postoperative care instructions are not followed.
• Recurrence or Incomplete Correction: Proper footwear and adherence to postoperative guidelines are crucial to prevent recurrence or incomplete correction of deformities.
• Nerve Damage: While minimized by the small incision, there is still a slight risk of nerve irritation or damage.
• Malalignment: If the bones do not heal in the correct position, further intervention might be required.

Conclusion

Minimally invasive metatarsal osteotomy (DMMO) represents a significant advancement in the surgical treatment of forefoot pain and deformities. By utilizing a small incision and avoiding hardware, DMMO offers patients a less invasive option with quicker recovery times and effective outcomes.