Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

Figure 3

DMMO intraoperative images (1st): using a small scalpel blade (SM64), an incision of 3-5 mm was made parallel to the extensor tendons at the dorsal side of the medial border of each M-head that needed to be shortened. The scalpel was advanced at an oblique angle of about 45° until it reached the dorsal aspect of the distal MB at the level of the neck (A). Through the same incision, first a bone rasp was inserted, using it to separate the periosteum at the level of osteotomy (B). Then, a Shannon Isham burr (2.0 × 12 mm) was introduced until it reached the metatarsal neck (C). Fluoroscopy was used to confirm the correct position of the osteotomy site on the distal metaphysis of the MB (D).