Ostectomy, complete excision; fifth metatarsal head
CPT4 code
Name of the Procedure:
Ostectomy, complete excision; fifth metatarsal head
(Common name: Fifth metatarsal head resection)
Summary
An Ostectomy of the fifth metatarsal head involves the surgical removal of the head of the fifth metatarsal bone (a bone in the foot). This procedure is typically performed to alleviate pain and improve foot function.
Purpose
This procedure is performed to address conditions such as:
- Painful bunions on the fifth metatarsal head (commonly known as a tailor’s bunion or bunionette)
- Arthritis affecting the fifth metatarsal head
- Severe deformity or injury to the fifth metatarsal head
The goal is to relieve pain, correct deformities, and improve foot function.
Indications
This procedure is indicated for patients who experience:
- Persistent pain in the fifth metatarsal region that does not improve with conservative treatments
- Visible deformity of the fifth metatarsal
- Difficulty wearing shoes due to foot shape
Patient criteria include:
- A confirmed diagnosis through physical examination and imaging tests
- Trial of non-surgical treatments (e.g., orthotics, medications) without sufficient relief
Preparation
- Patients may be advised to fast for several hours prior to the procedure
- Medication adjustments may be necessary, especially blood thinners
- Pre-operative physical examination and imaging studies to assess the extent of deformity or damage
- Pre-surgical clearance may be needed depending on the patient’s overall health
Procedure Description
- Anesthesia: Local anesthesia with sedation or general anesthesia is administered.
- Incision: The surgeon makes an incision over the fifth metatarsal head.
- Resection: The head of the fifth metatarsal is carefully removed using surgical tools.
- Closure: The incision is closed with sutures, and a sterile dressing is applied.
Tools Used: Scalpel, surgical scissors, bone saw, sutures. Anesthesia Details: Local anesthesia with sedative or general anesthesia may be used depending on patient and procedure specifics.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
This procedure is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic or podiatric surgeon to perform the procedure
- Anesthesiologist to manage anesthesia
- Nursing staff to assist during the procedure and in the recovery room
Risks and Complications
Common risks include:
- Infection at the surgical site
- Bleeding or hematoma formation
- Swelling and bruising
Rare risks may involve:
- Nerve damage leading to numbness or tingling
- Adverse reactions to anesthesia
- Non-healing of the bone
Benefits
- Pain relief
- Improved ability to wear shoes comfortably
- Enhanced foot function and mobility
Patients may begin to notice benefits within a few weeks, with optimal results typically seen after full recovery.
Recovery
- Patients will need to keep the foot elevated and avoid putting weight on it initially.
- Pain management with medications as prescribed.
- Follow-up appointments to monitor healing and remove sutures.
- Physical therapy may be recommended to restore foot function.
- Full recovery may take several weeks to months depending on the patient’s health and adherence to post-operative care instructions.
Alternatives
- Non-surgical treatments like orthotics, physical therapy, and medications
- Less invasive surgical procedures depending on the specific condition
Pros and Cons:
- Non-surgical treatments may offer symptom relief without surgery but may not be effective in severe cases.
- Less invasive procedures may involve shorter recovery times but may not address severe deformities effectively.
Patient Experience
During the procedure, patients will be under anesthesia and should not feel pain. Post-procedure, some discomfort and swelling are expected, managed with prescribed pain medications. The patient will have to follow specific care instructions, including keeping the foot elevated and attending follow-up appointments for optimal recovery.