|Beitragstitel||An original technique to address an intermetatarsal coalition|
Coalition of the forefoot is rare. There are less than ten reports in the literature. Therefore, there is no guideline for their management and every case has to be treated individually. We report a case and the surgical technic we used to treat it.
A 18 yo man has been suffering 2 years from pain at the lateral border of the right 5th metatarsal head, in his sports shoe. Physical examination revealed a painful hyperkeratosis at the lateral aspect of the 5th metatarsal head, a varus deviation and stiffness of the 5th toe, creating a conflict with the 4th toe. The x-rays showed a coalition between the diaphysis of the 4th and the head of the 5th metatarsals with a distal varus deviation. The 5th metatarsal head was deviated towards plantar by 11mm in relation to the 4th metatarsal head.
The goal was to narrow the forefoot, to elevate the 5th metatarsal head, and to suppress the conflict between the 4th and 5th toes. The biomechanical requirement was to avoid any modification of the healthy cuboïdo-metatarsal joints and to preserve the attachment of the short peroneal tendon. We decided, to resect the coalition, and to realize a suspended distal osteotomy of the 5th metatarsal head. The distal 5th metatarsal was derotated into valgus and fused to the previous basis of the coalition on the 4th metatarsal. An arthrodesis between the bases of the 4th and 5th metatarsal was performed. The patient was allowed to bear weight as tolerated in a postoperative shoe with rigid rocker bottom sole for 6 weeks.
At 6 months after surgery, the patient had no complaint and played basketball again. There was no need for specific shoe or insole. The final radiographs showed a complete consolidation with adequate realignment of the forefoot.
In this case, the main problem was the width of the forefoot, creating a conflict with the shoe. We shrunk the forefoot and created a harmonious arch of the metatarsal heads. We didn’t touch the 4th ray because it was clinically well aligned.
Metatarsal coalition is rare with only 8 isolated non-syndromic cases reported in the literature. If surgical treatment is required, several techniques are suggested in the literature, all with pretty good results. To our knowledge, the technique proposed here has never been described before and adds, therefore, a possible alternative, to the few previously reported surgical solutions.