BRT Osteotomy in Metatarsalgia

Isolated plantar callus is an excellent indication for BRT osteotomy of the corresponding meta-tarsal.

Similarly, the BRT osteotomy can relieve metatarsalgia on several rays.

2nd ray metatarsalgia with hallux valgus deformity can be treated either by Ml scarf lowering for mild deformity without excess of 2nd metatarsal length, or by Weil osteotomy of the 2nd metatarsal when it is too long. At last, BRT 2nd metatarsal osteotomy is indicated when the metatarsalgia is moderate or severe but without excess of length of the 2nd ray and without possibility to lower the 1st metatarsal - i.e. small first intermeta-tarsal angle.

Metatarsalgia

Fig. 18c3. Place of the BRT osteotomy for 2nd ray metatarsalgia combined with hallux deformity.

2. The BRT osteotomy is indicated when the hallux valgus correction does not allow to lower enough the first metatarsal (small intermetatarsal angle).

3. With a large intermetatarsal angle, the scarf osteotomy provides a large lowering of the first metatarsal which is enough for 2nd ray metatarsalgia relieving.

4. When the 2nd metatarsal is very long comparatively to the 1st and the 3rd metatarsals, both in a dorso-plantar and a medial oblique X-ray view, the Weil osteotomy has to be performed instead of the BRT osteotomy.

2nd Metatarsalgia

Fig. 18c4. BRT osteotomy in addition to Weil osteotomy.

It is performed when a metatarsal head remains too low. This case is rarely encountered.

Fig. 18c4. BRT osteotomy in addition to Weil osteotomy.

It is performed when a metatarsal head remains too low. This case is rarely encountered.

Metatarsalgia

Fig. 18c5. BRT osteotomy. Other indications for metatarsalgia.

1. The 3rd metatarsal osteotomy is combined to 2nd cuneo-metatarsal fusion.

2. BRT osteotomy for metatarsalgia with sesamoidal metatarsal arthritis.

3. Indication of BRT osteotomy on the 2nd and 3rd metatarsals for metatarsalgia with trophic troubles and hallux valgus.

Fig. 18c5. BRT osteotomy. Other indications for metatarsalgia.

1. The 3rd metatarsal osteotomy is combined to 2nd cuneo-metatarsal fusion.

2. BRT osteotomy for metatarsalgia with sesamoidal metatarsal arthritis.

3. Indication of BRT osteotomy on the 2nd and 3rd metatarsals for metatarsalgia with trophic troubles and hallux valgus.

Cuneo Metatarsal Joint Fusion

Fig. 18c6. BRT osteotomy. Emerging MTP subluxation.

It seems to be an indication of this osteotomy, but we have to take care of incomplete correction.

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