{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:00:42Z","timestamp":1791975642937,"version":"4.4.0"},"reference-count":18,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Introduction: Distal intracapsular minimally invasive osteotomies (DICMOs) for central metatarsals are described as intracapsular procedures; however, neither their intracapsular location throughout the entire cut nor the optimal anatomical position for their execution have been fully validated. The aim of this study was to assess the geometric position of the DICMO osteotomy in the central metatarsals (third and fourth) and quantify associated anatomical damage when performed under three different guidance modalities: anatomical palpation, fluoroscopic control, and ultrasound guidance. Material and methods: An experimental cadaveric study was conducted using 29 fresh specimens (11 males, 18 females), contributing a total of 58 central metatarsals (third and fourth). All specimens underwent a DICMO-type metatarsal osteotomy. Osteotomies were randomly allocated to three intervention groups: (1) ultrasound (n = 20), (2) fluoroscopy (n = 19), and (3) anatomical guidance (n = 19). Metatarsal length, the distance between the osteotomy line and the articular surface, and post-dissection soft-tissue damage were recorded. Results: After dissection, all osteotomies were confirmed to be intracapsular. A constant proportional relationship was identified between osteotomy location and metatarsal length: distance to the joint line = 0.239 \u00d7 metatarsal length. This relationship was independent of the guidance technique used. Only one iatrogenic lesion was observed: an articular cartilage injury of a third metatarsal in the anatomical-guidance group. Conclusions: The optimal position for DICMO osteotomy placement is approximately 24% of the total distal metatarsal length. This ensures an intracapsular trajectory and may contribute to intrinsic osteotomy stability. Image guidance\u2014either fluoroscopy or ultrasound\u2014appears essential to optimize outcomes and prevent avoidable anatomical damage.<\/jats:p>","DOI":"10.3390\/reports9010066","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T15:57:29Z","timestamp":1771516649000},"page":"66","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Geometric Assessment and Tissue Damage Control in Anatomically, Ultrasonographically, and Fluoroscopically Guided Intracapsular DICMO Osteotomies Conducted on Cadaveric Specimens"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4492-5959","authenticated-orcid":false,"given":"Mario","family":"Su\u00e1rez-Ortiz","sequence":"first","affiliation":[{"name":"Cl\u00ednica Podosalud, C\/Sep\u00falveda 121, 28011 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6249-7556","authenticated-orcid":false,"given":"Mar\u00eda del Mar","family":"Ruiz-Herrera","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Ruiz-Herrera, C\/Trinidad 14, 13600 Alc\u00e1zar de San Juan, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"L\u00f3pez-Vigil","sequence":"additional","affiliation":[{"name":"Department of Nursing and Physiotherapy, Campus de Ponferrada, Universidad de Le\u00f3n, 24401 Le\u00f3n, 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":"Department of Podiatry, School of Medicine and Health Sciences, Universidad Cat\u00f3lica de Valencia San Vicente M\u00e1rtir, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sof\u00eda","family":"Mora-Pardo","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Podosalud, C\/Sep\u00falveda 121, 28011 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5536-2509","authenticated-orcid":false,"given":"Alfonso","family":"Mart\u00ednez-Nova","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Extremadura, 10600 Plasencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1533-038X","authenticated-orcid":false,"given":"Rodrigo","family":"Mart\u00ednez-Quintana","sequence":"additional","affiliation":[{"name":"Department of Maths, University of Extremadura, 10600 Plasencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"ref_1","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_2","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_3","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.fas.2018.03.002","article-title":"Clinical and radiological outcomes after Weil osteotomy versus DMMO for metatarsalgia: Prospective study","volume":"25","author":"Johansen","year":"2019","journal-title":"Foot Ankle Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.fas.2018.06.004","article-title":"Clinical effectiveness and safety of Weil osteotomy versus DMMO in metatarsalgia: Systematic review","volume":"25","author":"Escobar","year":"2019","journal-title":"Foot Ankle Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1177\/1602400315","article-title":"Comparison of early outcome of Weil osteotomy and DMMO for lesser-toe metatarsalgia","volume":"24","author":"Yeo","year":"2016","journal-title":"J. Orthop. Surg."},{"key":"ref_6","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_7","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s00264-021-05146-7","article-title":"Shortening effect influence of Distal Minimally Invasive Metatarsal Osteotomy in primary metatarsalgia","volume":"46","author":"Tournemine","year":"2022","journal-title":"Int. Orthop."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/BTF.0000000000000093","article-title":"Distal metatarsal minimal invasive osteotomy (DMMO) for the treatment of metatarsalgia","volume":"15","author":"Golano","year":"2016","journal-title":"Tech. Foot Ankle Surg."},{"key":"ref_9","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":"Bruno","year":"2018","journal-title":"Foot Ankle Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.fcl.2016.04.003","article-title":"Percutaneous Surgery for Metatarsalgia and the Lesser Toes","volume":"21","author":"Redfern","year":"2016","journal-title":"Foot Ankle Clin."},{"key":"ref_11","first-page":"59","article-title":"Retrospective review of distal minimally invasive metatarsal osteotomies performed over a 10-year period: A case series","volume":"12","author":"Gonzi","year":"2025","journal-title":"J. Foot Ankle Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/j.fcl.2019.08.011","article-title":"Distal Minimally Invasive Metatarsal Osteotomy (\"DMMO\" Procedure)","volume":"24","author":"Perera","year":"2019","journal-title":"Foot Ankle Clin."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-Vizcaino, C., Naranjo-Ruiz, C., Fern\u00e1ndez-Ehrling, N., Garc\u00eda-Vicente, S., Nieto-Garc\u00eda, E., and Ferrer-Torregrosa, J. (2024). Impact of Minimally Invasive Intra-Capsular Metatarsal Osteotomy on Plantar Pressure Decrease: A Cross-Sectional Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13082180"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"101801","DOI":"10.1016\/j.foot.2021.101801","article-title":"Distal Metatarsal Minimally Invasive Osteotomy (DMMO): Surgical technique, variants, indications, and treatment decision-tree","volume":"47","author":"Coillard","year":"2021","journal-title":"Foot"},{"key":"ref_15","first-page":"309","article-title":"Radiation safety in orthopaedic operating theatres. what is the current situation?","volume":"58","year":"2014","journal-title":"Rev. Esp. Cir. Ortop. Traumatol."},{"key":"ref_16","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_17","doi-asserted-by":"crossref","unstructured":"Naranjo-Ruiz, C., Mart\u00ednez-Nova, A., Canel-P\u00e9rez, M.A., 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_18","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/j.fas.2022.01.008","article-title":"Risks of injury in distal metatarsal minimally invasive osteotomy when comparing standard and modified techniques: A cadaveric study","volume":"28","author":"Auch","year":"2022","journal-title":"Foot Ankle Surg."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/1\/66\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T16:09:15Z","timestamp":1771517355000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/1\/66"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["reports9010066"],"URL":"https:\/\/doi.org\/10.3390\/reports9010066","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]}}}