{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:33:26Z","timestamp":1792802006889,"version":"4.5.0"},"reference-count":36,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T00:00:00Z","timestamp":1754697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Minimally invasive distal metatarsal osteotomy (DMMO) has established itself as an effective surgical technique for the treatment of metatarsalgia, notable for its reduced postoperative pain and faster recovery. However, doubts remain regarding the frequency and nature of postoperative complications. The objective of this systematic review and meta-analysis was to evaluate the incidence of the most frequent complications associated with the DMMO technique, including prolonged edema, delayed bone healing, transfer metatarsalgia, floating toe, and persistent pain. Materials and Methods: A systematic review was conducted following the PRISMA 2020 guidelines, with the protocol registered in the PROSPERO database (CRD420251067666). Searches were conducted in the PubMed, Scopus, and Web of Science databases, including clinical studies published between 2010 and 2025. The inclusion criteria covered studies in adults treated with DMMO and reporting postoperative complications. The methodological quality assessment was performed using Joanna Briggs Institute (JBI) tools according to the design of each study. Random-effects models were used for the meta-analyses, assessing heterogeneity using the I2 statistic. Results: Fifteen studies with a total sample of more than 493 patients were included. Prolonged edema was the most common complication (30.91%), followed by delayed bone healing (14.9%), transfer metatarsalgia (12.73%), floating toe (10.45%), and persistent pain (8.5%). Less frequent complications included nonunion, infections, necrosis, and bone misalignments. The combined incidence of floating toe was 40% (I2 = 0%), while prolonged edema showed considerable heterogeneity (I2 = 88.3%). The overall quality of the evidence was considered moderate to low, mainly due to the predominance of observational studies. Conclusions: The DMMO technique represents a minimally invasive surgical option with generally favorable results. However, some complications, such as prolonged edema and floating toe, have a significant incidence. The methodological variability between studies highlights the need for standardized protocols and higher-quality prospective studies to establish the safety profile of this technique more accurately.<\/jats:p>","DOI":"10.3390\/medicina61081435","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T08:10:32Z","timestamp":1754899832000},"page":"1435","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Complications in Distal Minimally Invasive Metatarsal Osteotomies: Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"61","author":[{"given":"Ang\u00e9lica Mar\u00eda","family":"Fern\u00e1ndez-G\u00f3mez","sequence":"first","affiliation":[{"name":"Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente M\u00e1rtir, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7321-3707","authenticated-orcid":false,"given":"Eduardo","family":"Nieto-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente M\u00e1rtir, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonor","family":"Ram\u00edrez-Andr\u00e9s","sequence":"additional","affiliation":[{"name":"Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente M\u00e1rtir, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2710-2931","authenticated-orcid":false,"given":"Juan","family":"Vicente-Mampel","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, School of Medicine and Health Science, Catholic University of Valencia, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4617-7659","authenticated-orcid":false,"given":"Javier","family":"Ferrer-Torregrosa","sequence":"additional","affiliation":[{"name":"Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente M\u00e1rtir, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.mporth.2019.11.005","article-title":"Treating Metatarsalgia: Current Concepts","volume":"34","author":"Chahal","year":"2020","journal-title":"Orthop. Trauma"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.fcl.2019.08.001","article-title":"Scientific Evidence in the Treatment of Metatarsalgia","volume":"24","author":"Klammer","year":"2019","journal-title":"Foot Ankle Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"474","DOI":"10.5435\/00124635-201008000-00004","article-title":"Metatarsalgia","volume":"18","author":"Espinosa","year":"2010","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_4","first-page":"S165","article-title":"Metatarsalgia: From Pathophysiology to Surgical Correction","volume":"105","author":"Besse","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.fcl.2019.08.008","article-title":"Mechanical Basis of Metatarsalgia","volume":"24","author":"Maceira","year":"2019","journal-title":"Foot Ankle Clin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.fcl.2019.07.001","article-title":"The Role of First Ray Insufficiency in the Development of Metatarsalgia","volume":"24","author":"Walker","year":"2019","journal-title":"Foot Ankle Clin."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e138","DOI":"10.3928\/01477447-20181206-06","article-title":"Overview of Metatarsalgia","volume":"42","author":"Charen","year":"2019","journal-title":"Orthopedics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"821","DOI":"10.2214\/AJR.17.18460","article-title":"Central Metatarsalgia and Walking on Pebbles: Beyond Morton Neuroma","volume":"210","author":"Ganguly","year":"2018","journal-title":"Am. J. Roentgenol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bueno Fermoso, R., Morales Lozano, M.R., Nieto Cordero, M., Mart\u00ednez Rinc\u00f3n, C., Garc\u00eda-Fern\u00e1ndez, P., and Gonz\u00e1lez Fern\u00e1ndez, M.L. (2024). Differences and Similarities in the Feet of Metatarsalgia Patients with and without Rheumatoid Arthritis in Remission. J. Clin. Med., 13.","DOI":"10.3390\/jcm13102881"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s13047-016-0176-z","article-title":"The Effect of Foot Orthoses with Forefoot Cushioning or Metatarsal Pad on Forefoot Peak Plantar Pressure in Running","volume":"9","author":"Baur","year":"2016","journal-title":"J. Foot Ankle Res."},{"key":"ref_11","unstructured":"Vulcano, E., Johnson, A.H., and Schipper, O.N. (2023). Distal Minimally Invasive Metatarsal Osteotomy. Minimally Invasive Foot and Ankle Surgery. A Percutaneous Approach, Wolters Kluwer."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s13018-019-1159-0","article-title":"Evaluation of Results after Distal Metatarsal Osteotomy by Minimal Invasive Surgery for the Treatment of Metatarsalgia: Patient and Anatomical Pieces Study","volume":"14","author":"Rodriguez","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez Vizcaino, C., Naranjo-Ruiz, C., Fern\u00e1ndez-Erhling, N., Garcia-Vicente, S., Nieto-Garcia, E., and Ferrer-Torregrosa, J. (2024). Impact of Minimally Invasive Intra-Capsular Metatarsal Osteot-2 Omy on Plantar Pressure Decrease: A Cross-Sectional Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13082180"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Naranjo-Ruiz, C., Mart\u00ednez-Nova, A., de Los \u00c1ngeles Canel-P\u00e9rez, M., L\u00f3pez-Vigil, M., Ferrer-Torregrosa, J., and Barrios, C. (2021). Influence of Foot Type on the Clinical Outcome of Minimally Invasive Surgery for Metatarsalgia. A Prospective Pilot Study. Front. Surg., 8.","DOI":"10.3389\/fsurg.2021.748330"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.fas.2020.01.004","article-title":"Tips, Quips and Pearls: Ultrasound-Guided Distal Metatarsal Minimal Invasive Osteotomy (US-DMMO)","volume":"27","author":"Vaquero","year":"2021","journal-title":"Foot Ankle Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S57","DOI":"10.1016\/j.otsr.2011.07.003","article-title":"Distal Osteotomy of the Lateral Metatarsals: A Series of 72 Cases Comparing the Weil Osteotomy and the DMMO Percutaneous Osteotomy","volume":"97","author":"Henry","year":"2011","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"153","DOI":"10.30795\/jfootankle.2022.v16.1639","article-title":"Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Lesser Toe Metatarsalgia: A Case Series of 195 Osteotomies","volume":"16","author":"Oliveira","year":"2022","journal-title":"J. Foot Ankle"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1177\/1602400315","article-title":"Comparison of Early Outcome of Weil Osteotomy and Distal Metatarsal Mini-Invasive Osteotomy for Lesser Toe Metatarsalgia","volume":"24","author":"Yeo","year":"2016","journal-title":"J. Orthop. Surg."},{"key":"ref_19","first-page":"108","article-title":"Osteotom\u00edas Distales de Los Metatarsianos Menores Realizadas Por Cirug\u00eda Abierta vs Cirug\u00eda Percut\u00e1nea En El Tratamiento de Las Metatarsalgias","volume":"50","author":"Miranda","year":"2015","journal-title":"Rev. Espa\u00f1ola Cirug\u00eda Osteoartic."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Biz, C., Corradin, M., Kanah, W.T.K., Dalmau-Pastor, M., Zornetta, A., Volpin, A., and Ruggieri, P. (2018). Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?. Biomed. Res. Int., 2018.","DOI":"10.1155\/2018\/1947024"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"411","DOI":"10.35366\/104567","article-title":"Resultados Cl\u00ednicos Del Tratamiento de La Metatarsalgia Mec\u00e1nica Sin Afectaci\u00f3n Del Primer Metatarsiano","volume":"35","author":"Forriol","year":"2021","journal-title":"Acta Ortop. Mex."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_23","first-page":"195","article-title":"Improving the Translation of Search Strategies Using the Polyglot Search Translator: A Randomized Controlled Trial","volume":"108","author":"Sanders","year":"2020","journal-title":"J. Med. Libr. Assoc. JMLA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s00402-025-05779-y","article-title":"Single Metatarsal Percutaneous Distal Metatarsal Osteotomy (DMMO) for 3rd Space Morton Neuroma Is Safe and Efficacious","volume":"145","author":"Confino","year":"2025","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1177\/1071100715598601","article-title":"Outcome of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Lesser Toe Metatarsalgia","volume":"37","author":"Haque","year":"2016","journal-title":"Foot Ankle Int."},{"key":"ref_26","first-page":"2353","article-title":"Percutaneus Intermetatarsal Ligament Release and Minimally Invasive Distal Metatarsal Osteotomy for Treatment Second Intermetatarsal Space Syndrome","volume":"33","year":"2023","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1177\/1938640017750251","article-title":"Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Learning Curve","volume":"11","author":"Krenn","year":"2018","journal-title":"Foot Ankle Spec."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.fas.2017.04.012","article-title":"Percutaneous Distal Osteotomy of Lesser Metatarsals (DMMO) for Treatment of Metatarsalgia with Metatarsophalangeal Instability","volume":"24","author":"Magnan","year":"2018","journal-title":"Foot Ankle Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.foot.2018.12.003","article-title":"Minimally Invasive Distal Metaphyseal Metatarsal Osteotomy (DMMO) for Symptomatic Forefoot Pathology\u2014Short to Medium Term Outcomes from a Retrospective Case Series","volume":"38","author":"Malhotra","year":"2019","journal-title":"Foot"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"101661","DOI":"10.1016\/j.foot.2019.101661","article-title":"MIS Distal Metatarsal Metaphyseal Osteotomy in the Treatment of Metatarsalgia: MOXFQ Patient Reported Outcomes","volume":"43","author":"McMurrich","year":"2020","journal-title":"Foot"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s00132-019-03848-w","article-title":"Treatment of Plantar, Neuropathic and Metatarsal Ulcers by Minimally Invasive Metatarsal Osteotomy","volume":"49","author":"Mehlhorn","year":"2020","journal-title":"Orthopade"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1177\/10711007211034849","article-title":"Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes","volume":"43","author":"Neunteufel","year":"2022","journal-title":"Foot Ankle Int."},{"key":"ref_33","first-page":"17","article-title":"Minimally Invasive Distal Metatarsal Osteotomy in the Treatment of Primary Metatarsalgia","volume":"17","author":"Wong","year":"2013","journal-title":"J. Orthop. Trauma Rehabil."},{"key":"ref_34","unstructured":"(2025, June 15). JBI Critical Appraisal Tools|JBI. Available online: https:\/\/jbi.global\/critical-appraisal-tools."},{"key":"ref_35","first-page":"2127","article-title":"Methodological Quality of Case Series Studies: An Introduction to the JBI Critical Appraisal Tool","volume":"18","author":"Munn","year":"2019","journal-title":"JBI Database Syst. Rev. Implement Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.ciresp.2013.08.002","article-title":"Sistema GRADE: Clasificaci\u00f3n de La Calidad de La Evidencia y Graduaci\u00f3n de La Fuerza de La Recomendaci\u00f3n","volume":"92","year":"2014","journal-title":"Cir. Esp."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/8\/1435\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:27:12Z","timestamp":1760034432000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/8\/1435"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,9]]},"references-count":36,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["medicina61081435"],"URL":"https:\/\/doi.org\/10.3390\/medicina61081435","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,9]]}}}