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Metatarsal Surgery
There are five metatarsal bones in each foot.
These bones are the long bones behind each toe. The metatarsal bone
behind the big toe is called the first metatarsal. The metatarsal bone
behind the little toe is called the fifth metatarsal. The most common
metatarsal surgery is preformed on the first metatarsal for the correction of bunion deformity. The second most common metatarsal surgery is on the fifth metatarsal for the correction of tailor's bunion deformity. This article will address metatarsal surgery of the other metatarsals. Surgery
on the remaining metatarsal bones is performed infrequently. When
surgery is performed on the second, third, or fourth metatarsal bones,
it is generally for the treatment of painful callouses on the bottom of
the foot or for the treatment of non-healing ulcerations on the ball of
the foot. Patients with rheumatoid arthritis may require surgery of the metatarsals,
which is discussed in another section. Also surgery of the metatarsals
may be necessary in instances of trauma of the foot where the
metatarsal bones may have been fractured. This article will discuss
elective metatarsal surgery. Painful callouses on the ball
of the foot are due to an abnormal alignment of the metatarsal bones.
If a metatarsal bone is lower than the others, excessive weight is
placed on this area of the foot, and a painful callous may form. In
people with diabetes, these areas of excessive pressure may break down
and form open sores or ulcerations. Initial treatment generally consist of using a functional or accommodative orthotic to reduce the pressure to these areas. If this is not successful, metatarsal surgery may be considered. The Surgery The
surgery consists of cutting the metatarsal bone just behind the toe.
Generally, the bone is cut all the way through, and then manually
elevated and held in its corrected position with a metal pin or screw.
Following the surgery, the patient may be placed in a cast, or may be
required to use crutches for several weeks. If a pin is used to hold
the bone in place, it is generally removed in three to four weeks.
Removal of the pin can be done in the doctor's office without the need
for anesthesia. While the pin is in place, the patient should keep the
foot dry to prevent infection. Generally it takes a total of six to
eight weeks, or longer, for the bone to heal. During this healing
period, the foot should be protected from excessive weight bearing.
Walking prematurely on the foot can cause the bone to shift and heal in
an incorrect position. This is the most common cause of failure with
this surgery. Some studies indicate a failure rate as great as 60%. If
the bone shifts downward, or is not elevated enough at the time of
surgery, the painful callous may return. If the bone is elevated too
much, a painful callous may form under the metatarsal next to the one
which was operated on. Some surgeons will also
cut out the painful callous on the bottom of the foot when they perform
the metatarsal surgery. Rarely will a foot surgeon remove the painful
callous without also performing the metatarsal surgery. Without
correcting the metatarsal alignment, the painful callous is almost
certain to return. Most surgeons prefer to do the
surgery in an outpatient surgery center or hospital. In this setting,
intra-venous sedation or general anesthesia can be used for the
patientﾒs comfort. At the conclusion of the
surgery, the surgeon places a gauze bandage on the foot. Generally, the
bandage stays in place until the patientﾒs first follow up visit with
the doctor. The skin stitches are removed in ten to fourteen days. If
there are stitches in the bottom of the foot, they may remain in place
for three weeks. The foot should be kept dry while the stitches and/or
pin are in place to help prevent infection. May surgeons will have the
patients wear a below the knee cast and/or use crutches for six to
eight weeks. Other surgeons will allow the patient to wear a stiff-sole
post-operative shoe, and allow limited walking on the foot. Recovery Time The
time required to be off work will vary with the demands of the personﾒs
job. A minimum of one week off work would be advisable with the patient
staying at home with the foot elevated above the heart. Possible Complications Complications
associated with this surgery are: infection, failure of the bone to
heal in its correct position resulting in the return of the painful
callous or transfer of the callous to a new location, delays or failure
of bone healing, stress fractures of adjacent metatarsals, or excessive
swelling. A common occurrence following the surgery is elevation of the
toe associated with the elevated metatarsal bone that was operated on. Metatarsal Surgery to Treat Diabetic Ulcerations Diabetic
patients with non-healing ulcerations on the ball of the foot may
undergo a different type of metatarsal surgery. In this instance, the
section of the metatarsal bone associated with the excessive pressure,
called the metatarsal head, may be removed entirely. This is a
relatively common and successful surgery that aids in the healing of
the ulceration on the bottom of the foot. Possible complications
with this surgery include infection, failure of the procedure to heal
the ulceration, or the development of new ulcerations in adjacent areas
on the ball of the foot. If the patient has poor circulation, further
complications may be failure of the surgical sight to heal, or gangrene
with partial loss of the foot or leg. In most instances of metatarsal surgery, the patient should use an orthoticin
their shoe after the surgery has healed. This is especially important
for the diabetic patient. The orthotic will reduce the risk of
reoccurrence or the development of new areas of callous formation or
tissue break down.
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