What is the Impact of First Metatarsal Shortening?
Transfer metatarsalgia is a well-documented complication following hallux valgus correction, often related to excessive shortening of the first metatarsal. This meta-analysis, presented as an abstract at the 2025 ACFAS ASC, evaluates the relationship between the degree of metatarsal shortening and the incidence of postoperative transfer metatarsalgia, offering insights for surgical planning and technique selection.
The authors included fifteen studies involving 1,550 patients in their analysis. Their review examined overall incidence trends and they performed subgroup analyses based on surgical methods, patient demographics, and foot morphology. They shared that clear correlation emerged between the degree of metatarsal shortening and the development of metatarsalgia. Shortening under 3 mm was associated with a low incidence rate of 6.1%, while shortening between 3–4 mm increased that risk to 15%. Shortening beyond 4 mm significantly elevated the incidence to 27%.1
Surgical technique played a pivotal role. Chevron osteotomies, which more commonly preserved length, showed the lowest incidence of metatarsalgia (6.5%). Conversely, Wilson osteotomies—typically resulting in greater shortening—were linked to the highest incidence (30%). These findings reinforce the advantage of length-preserving techniques in reducing postoperative complications.1
The authors also found that patient-specific factors influenced outcomes. Older patients (over 60 years of age) demonstrated higher complication rates regardless of shortening degree. Additionally, individuals with a longer second metatarsal were more prone to transfer metatarsalgia when the first metatarsal was shortened more than 3 mm.1
The authors contend that, to minimize risk of postoperative transfer metatarsalgia, surgeons should aim to limit first metatarsal shortening to less than 3 mm. Chevron osteotomies may be especially beneficial for high-risk populations due to their length-preserving nature. In total, they emphasized the value of choosing a tailored surgical plan, individualized for each patient, and including thoughtful technique selection.1
Reference
1. Armout N, Gallagher AL, Brucato M. Impact of first metatarsal shortening: implications and insights. Abstract presented at the American College of Foot and Ankle Surgeons' Annual Scientific Conference, March 26-28, 2025, Phoenix, AZ.
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