Evaluación prospectiva de la eficacia del tratamiento quirúrgico mínimamente invasivo frente al tratamiento conservador en la metararsalgia primaria

Résumé

Introduction: Metatarsalgia is considered the main cause of foot pain in adults; up to 10% of the general population may suffer from metatarsalgia at some point in their lives. Pain and increased pressure under one or more metatarsal heads are common clinical symptoms. Treatment is by conservative management; and when unsuccessful, surgical treatment, either open-field or minimally invasive surgery, is indicated. The aim of this study is to evaluate the efficacy of conservative treatment and surgical treatment by performing minimally invasive osteotomies. Method: A prospective comparative study was performed with two cohorts, one group receiving conservative treatment and the other group undergoing minimally invasive surgical treatment. Fifty-seven patients were examined, 29 in the conservative treatment cohort and 28 in the surgical treatment cohort. Seventy-one minimally invasive central metatarsal osteotomies were performed in the 28 patients in the surgical treatment cohort. The mean age of the patients was 53 years, with a preponderance of women n= 43 (75.4%). Pain was assessed with the VAS scale, clinical and functional status was assessed with the AOFAS scale and plantar pressures were measured in the central metatarsal heads, in static and dynamic, pre-treatment and at six and twelve months. Results: The initial VAS scale assessment was similar in both cohorts (6.73±1.16 in the conservative cohort vs. 7.69±1.09 in the surgical cohort). At 12 months of treatment, the surgical cohort decreases almost to the absence of pain (2.34±2.80 versus 0.33±0.93). The mean total score on the AOFAS scale before starting treatment was slightly higher in the conservative cohort (51.07±11.59 versus 42.82±15.60) and improves its score by less than the surgical cohort at twelve months (71.38±15.38 versus 92.93±8.65). The function dimension of the AOFAS scale presents similar scores at baseline in both cohorts (19.79±5.77 versus 23.25±7.79), increasing at the end of the study in both cohorts, approaching the maximum score in the surgical cohort (31.83±7.05 versus 41.82±3.51). In the alignment category of the AOFAS scale the conservative cohort starts from a medium-high score versus the surgical cohort (9.21±4.57 versus 4.68±5.96), and maintains its score at twelve months while the surgical cohort improves significantly (9.14±3.93 versus 13.25±3.08). The mean pressures between cohorts do not show significant differences before treatment measurement. They decreased significantly under the second metatarsal head in static and under the third and fourth head in dynamic through time, only in the surgical cohort. Conclusion: Minimally invasive osteotomies provide a more effective therapeutic alternative to conservative treatment for primary metatarsalgia, improving the clinical and functional status and decreasing the plantar pressures supported by the metatarsal heads.