As an extra-articular osteotomy, the distal metatarsal minimally invasive osteotomy (DMMO) affords the surgeon the ability to treat both static and propulsive metatarsalgia with predictable healing and a reduced risk of stiffness, scarring, and wound healing complications. The development of more advanced variations of this procedure expands the range of conditions that can be successfully treated by the surgeon. The percutaneous osteotomy is an alternative to open surgery that offers immediate weight bearing. The efficacy of the DMMO has been demonstrated by growing evidence, with satisfactory clinical results and less soft tissue injury.