DMMO and the Floating Toe

Elena Neunteufel, MD, et al. case series, "Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes," garnered its fair share of likes on various social media channels over the past week. It's also one of the few articles on subject.

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomies (DMMO)? Why? Open lesser metatarsal osteotomies are vexed by cosmesis issues, and dorsiflexion, aka “floating toe,” remains one of the most common challenges. In contrast, purported benefits of DMMO include:

• a lower cost (on account of no fixation)

• reduced soft tissue dissection

• higher patient satisfaction

• better cosmesis

• reportedly, fewer complications, including floating toe

But does it ... really?

Overall, the report details the use of the DMMO in 31 feet. Significant improvements in many of the clinical outcome scores, pedobarographic changes and high patient satisfaction are all positive takeaways. Nonetheless, the procedure is not without complications, including considerably shortening and excessive dorsiflexion.

If it ain't broke, don't fix it

Minimally invasive surgery is here to stay, at least for the next decade. However, it will be interesting to see just how many of these techniques are truly adopted by surgeons – especially against mainstay open procedures that provide consistently reproducible outcomes.