Introduction and purpose: Many techniques for the treatment of metatarsalgia have been described. Weil’s osteotomy causes loss of movement of the metatarsophalangeal (MTP) joint. Some authors associate this deficiency with a hypertrophic soft tissue scar on the dorsal part of the MTP joint. The purpose of this study is to assess the results of distal osteotomy of the small metatarsals carried out by means of a mini-invasive (MIS) technique.

Materials and methods: We retrospectively reviewed 43 feet, 111 osteotomies performed between 2002 and 2006. The mean age of the patients was 51.8 years. In 45.45% of cases there were associated hallux pathological conditions and in 57.5% there were alterations of the smaller toes. Patients underwent clinical and functional assessment. Radiologically it was possible to determine the metatarsal formula, the rate of consolidation and metatarsal shortening.

Results: The follow-up period was 15 months. From the functional and cosmetic point of view 97% of the patients considered their results were excellent or good. Radiologically there was an average shortening of 2.88 mm; in 20% of cases there was a change to a more physiological metatarsal formula and union was achieved in all cases without significant delays. Complications seen: one case of cellulitis and 3 transfer metatarsalgias.

Conclusions: MIS seems an appropriate surgical technique for the treatment of metatarsalgias of the smaller toes associated or not with forefoot surgery. Good clinical and cosmetic outcomes are seen in more than 95% of cases.