Transfer Metatarsalgia after MIS Hallux Valgus
One of the biggest knocks on MIS bunion surgery is transfer metatarsalgia.
The assumption has always been that the burr causes shortening and that shortening leads to lateral overload.
This study challenges that directly.
A 2 mm shortening alone did not increase lateral forefoot pressure.
What did?
Dorsal displacement of the first metatarsal head.
That is the key.
If you dorsiflex the capital fragment, you unload the first ray and shift pressure laterally. That is the mechanism for transfer metatarsalgia.
If anything, slight plantar positioning restores medial loading.
This is not a procedure problem. It is a technique problem.
MIS bunion surgery requires precise control of the sagittal plane. That is where the learning curve lives.
The takeaway is simple:
Respect the first ray.
Control the sagittal plane.
Do not dorsally elevate the head.
That is how you avoid transfer metatarsalgia.