Plantar approach for treatment of brachymetatarsia: A novel approach with an aesthetic consideration

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 75; no. 5; pp. 1668 - 1673
• Main Authors: Zhang, Ning, Xu, Hua, Huang, Zheng, Wang, Yang, Li, Zhengxun, Xu, Wenpeng, Hu, Yong
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2022
• Subjects: Aesthetics; Approach; Congenital deformities; Lesser ray deformities; Therapeutic techniques; Therapeutic techniques; Aesthetics; Lesser ray deformities; Congenital deformities; Approach
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2021.11.078

In the past, open osteotomy was always performed through a dorsal approach in the surgical treatment of brachymetatarsia, which created scar formation on the dorsal skin, subsequently resulting in dissatisfaction with cosmetic results. In this study, we provided a plantar approach to avoid forming scars on the dorsal side. A retrospective review was conducted in nine patients (13 feet) with brachymetatarsia treated with an open osteotomy and gradual bone lengthening through a plantar approach. Visual analogue scale (VAS) was used to evaluate the satisfaction of foot appearance, and we designed a questionnaire called appearance index (AI) to assess the influence of foot appearance on quality of life after surgery. The complications were also recorded during the follow-up. The patients were followed up for 34.8 ± 23.7 months. All cases were healed with a time of 64.4 ± 7.1 days and a healing index of 44.1 ± 7.8 d/cm. Satisfaction VAS for foot appearance improved from a preoperative score of 1.7 ± 1.3 points to a postoperative score of 9.3 ± 0.5 points. The AI improved from a preoperative score of 9.2 ± 0.8 points to a postoperative score of 0.6 ± 0.7 points. Complications were observed in three feet (23.1%), but none was related to the plantar approach. In conclusion, the plantar approach for metatarsal osteotomy and pins fixation was a safe and efficient technique with a satisfactory cosmetic result for the patients. No complications related to the novel approach, such as neurovascular injury, were reported.