The lesion usually found on the plantar aspect of the foot under a metatarsal head or metatarsophalangeal joint is almost invariably a plantar keratosis and not a plantar wart. Careful clinical examination and evaluation to distinguish between the true verruca plantaris and the plantar keratosis is of primary importance since the true verruca plantaris will respond to tissue-destroying methods of treatment, whereas the plantar keratosis is a pressure phenomenon and usually will not respond to such therapy. When all conservative measures have failed to eradicate a disabling plantar keratosis then, and only then, should metatarsal shortening be considered. The contra-indications to this procedure have been enumerated. The longest folloup after this procedure has been twelve years and the shortest, twelve months. Fifty-one patients have been followed for six years or more. In 87.4 per cent of this series the results were excellent. Of the remaining 12.6 per cent, 4.5 per cent were absolute failures in that the lesion recurred under the same metatarsal head. In the other 8.1 per cent, many of the patients were pleased with the end results despite the development of a plantar keratosis or a callus under an adjacent metatarsal head since this recurrence was not as disabling as the original lesion had been. .In some instances when a symptomatic disabling keratosis did develop under an adjacent metatarsal head, the patients, of their own volition, requested that the same procedure be performed to eradicate this subsequent lesion rather than undergo the various forms of local palliative therapy. There is no question that conservative treatment is very definitely indicated and will relieve a large number of patients who are disabled by this lesion. On the other hand, for those few patients in whom non-operative and local surgical procedures have failed, shortening of the metatarsal shaft should be considered.
Copyright 1966 by The Journal of Bone and Joint Surgery, Incorporated