28110 Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)

Name of the Procedure:

Partial excision of the fifth metatarsal head (bunionette ostectomy)

Summary

A bunionette ostectomy involves surgically removing part of the fifth metatarsal head to alleviate pain and discomfort caused by a bunionette, which is a bony bump on the outside of the fifth toe.

Purpose

This procedure aims to correct a deformity known as a bunionette or "tailor's bunion," which can cause pain, redness, and swelling in the affected area. The goal is to provide relief from these symptoms and improve the foot's function and appearance.

Indications

• Persistent pain and inflammation in the fifth toe area despite conservative treatments such as shoe modifications, orthotics, or anti-inflammatory medications.
• Difficulty in wearing shoes or performing daily activities due to the bunionette.
• Cosmetic concerns about the appearance of the foot.

Preparation

• Pre-procedure fasting, usually starting from midnight on the day before surgery.
• Adjustments to current medications as directed by the healthcare team.
• Preoperative diagnostic tests, which may include X-rays or other imaging studies to assess the severity of the bunionette and plan the surgical approach.

Procedure Description

1. The procedure begins with administering either local anesthesia with sedation or general anesthesia to ensure the patient feels no pain.
2. An incision is made over the fifth metatarsal head.
3. Special surgical instruments are used to carefully remove part of the bone (metatarsal head).
4. The incision is closed with sutures.
5. The foot is then bandaged and sometimes placed in a special shoe or boot to protect it.

Duration

The procedure typically takes around 1 to 2 hours.

Setting

Bunionette ostectomy is usually performed in an outpatient surgical center or a hospital setting.

Personnel

• Orthopedic surgeon or podiatric surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Surgical technicians

Risks and Complications

• Infection at the surgery site
• Excessive bleeding
• Nerve damage causing numbness or tingling
• Incomplete relief of symptoms or recurrence of the bunionette
• Delayed healing or bone healing complications

Benefits

Expected benefits include significant pain relief, improved foot function, and a better cosmetic appearance. Most patients experience these benefits shortly after the initial recovery phase.

Recovery

• Post-procedure care includes keeping the foot elevated, applying ice to reduce swelling, and taking prescribed pain medications.
• Avoid bearing weight on the affected foot as advised, typically for a few weeks.
• Follow-up appointments for suture removal and progress monitoring.
• Gradual return to normal activities with possible physical therapy for optimal recovery.

Alternatives

• Non-surgical options like shoe modifications, orthotic devices, and anti-inflammatory medications can be tried before opting for surgery.
• Other surgical techniques, such as metatarsal osteotomy or arthroplasty, can be considered based on individual cases and severity.

Patient Experience

During the procedure, patients will be under anesthesia and should not feel any pain. Post-surgery pain and discomfort can be managed with medications, and swelling typically subsides over a few weeks. Patients should experience progressive improvement in comfort and function as healing occurs.