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Metatarsal Osteotomy to Manage Metatarsal Prominence
Osteotomies of the lesser metatarsals are routinely performed to alleviate metatarsalgia, or forefoot pain localized to the plantar surface of the foot in the area of the metatarsal heads. The lesser metatarsal heads of the second, third, and fourth rays are most commonly involved. Nonsurgical management should be attempted first. Several osteotomy options exist to manage metatarsalgia that is refractory to nonsurgical treatment. These include the Weil osteotomy, diaphyseal shortening, the Hoke osteotomy, the Helal osteotomy, a diaphyseal and distal dorsal closing wedge osteotomy, a chevron osteotomy with dorsal displacement, and a stepcut shortening diaphyseal osteotomy described by Giannestras. There is no consensus as to which option offers the most reliable outcome with regard to relieving symptoms. To determine the best osteotomy technique, the clinician must first identify the type of deformity to be treated.