28112 Ostectomy, complete excision; other metatarsal head (second, third or fourth)

Name of the Procedure:

Ostectomy, Complete Excision of Other Metatarsal Head (Second, Third, or Fourth)

Summary

In an ostectomy of the metatarsal head, a surgeon removes the head (front end) of the second, third, or fourth metatarsal bone in the foot. This procedure is usually performed to alleviate severe pain or deformity resulting from various foot conditions.

Purpose

This procedure addresses conditions such as severe arthritis, chronic deformities, or complications due to bunions or hammertoes. The goal is to relieve pain, improve foot function, and enhance the patient's ability to walk comfortably.

Indications

• Severe, unrelenting pain in the forefoot
• Deformities like overlapping toes or misalignment
• Failure of conservative treatments such as medications, orthotics, or physical therapy
• Arthritis causing significant discomfort in the metatarsal region
• Inability to perform daily activities due to foot pain

Preparation

• Fasting for at least 8 hours before surgery
• Adjustments in medication as recommended by the doctor
• Preoperative diagnostic tests, such as X-rays or MRIs, to assess the foot structure
• Evaluation of overall health and fitness for surgery

Procedure Description

1. Anesthesia: The procedure is usually performed under general or regional anesthesia.
2. Incision: A small incision is made over the affected metatarsal head.
3. Excision: The surgeon uses specialized tools to remove the metatarsal head.
4. Realignment: If necessary, the surrounding structures are realigned.
5. Closure: The incision is closed with sutures or staples.
6. Dressing: The foot is bandaged and often placed in a surgical shoe or cast to protect the area.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity and any additional work required.

Setting

The surgery is performed in a hospital operating room, outpatient surgical center, or specialized orthopedic clinic.

Personnel

• Orthopedic surgeon or podiatrist
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Nerve damage leading to numbness or tingling
• Delayed or poor healing of the bone
• Recurrence of deformity
• Persistent or recurrent pain
• Blood clots

Benefits

• Significant reduction in foot pain
• Improved foot function and mobility
• Enhanced ability to walk and perform daily activities
• Correction of foot deformities, leading to better overall foot alignment

Recovery

• Initial rest and elevation of the foot
• Gradual return to weight-bearing activities as advised by the doctor
• Physical therapy to restore movement and strength
• Full recovery typically takes 6 to 8 weeks
• Regular follow-up appointments to monitor healing

Alternatives

• Conservative treatments like orthotics, physical therapy, and pain management
• Corticosteroid injections to reduce inflammation
• Less invasive surgeries, such as metatarsal osteotomy
• Pros and cons depend on the severity of the condition, with conservative options being less risky but potentially less effective for severe cases.

Patient Experience

During the procedure, the patient will be under anesthesia and feel no pain. Postoperatively, patients may experience swelling, discomfort, and pain, which is managed with medications and rest. Over time, pain should decrease, and mobility should improve.