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Fifth Metatarsal Osteotomy for Correction of Bunionette Deformity


Indications

  • Wide forefoot with symptomatic fifth metatarsal (5MT) head and medial deviation of fifth toe

  • Failure of nonoperative treatment (shoe modifications)

  • Weight-bearing anteroposterior (AP) foot radiograph demonstrating a widened fourth-fifth intermetatarsal angle (4/5 IMA)

Examination/Imaging

  • Wide forefoot

  • Symptomatic 5MT head and medial deviation of fifth toe

  • Widened 4/5 IMA (type II or type III bunionette deformity) on a weight-bearing AP foot radiograph ( Fig. 15.1 )

    FIG. 15.1

Treatment Options

  • Distal 5MT osteotomy typically reserved for prominent 5MT head without increased 4/5 IMA (type I deformity)

Surgical Anatomy

  • Essentially a mirror image of a bunion deformity

  • Widened 4/5 IMA, prominent 5MT head, and medial deviation of the fifth toe ( Fig. 15.3 )

    FIG. 15.3

  • Ligamentous attachments between fourth and fifth MT bases

  • Watershed area of poor vascular supply at 5MT base ( Fig. 15.4 )

    • Commonly associated with Jones fracture

    • Osteotomy should be distal to this watershed area

    FIG. 15.4

  • Sural nerve courses on dorsolateral aspect of 5MT

Anatomy Pitfalls

  • Avoid injuring the sural nerve.

  • An incision too plantar will make screw insertion more difficult.

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