Ostectomy, complete excision; first metatarsal head
CPT4 code
Name of the Procedure:
Ostectomy, complete excision; first metatarsal head
Common names: Removal of the first metatarsal head, Metatarsal head resection
Summary
An ostectomy involving complete excision of the first metatarsal head is a surgical procedure where the head of the first metatarsal bone in the foot is removed. This procedure is typically performed to alleviate pain and correct deformities in the foot.
Purpose
This procedure addresses conditions like severe arthritis, bone spurs, or deformities (such as bunions) in the first metatarsal head. The goals are to reduce pain, improve foot function, and correct deformities.
Indications
- Severe pain in the first metatarsal head due to arthritis or bone spurs
- Large bunions unresponsive to conservative treatments
- Deformities affecting foot mechanics and causing significant discomfort
Preparation
- Patients are usually instructed to fast for 8-12 hours before the procedure
- Medication adjustments may be necessary, particularly for blood thinners
- Pre-operative assessments may include X-rays, blood tests, and a physical exam
Procedure Description
- The patient is positioned, and anesthesia is administered (general or local with sedation).
- An incision is made over the first metatarsal head.
- Surgeons use specialized tools to carefully excise the metatarsal head.
- The incision is closed with sutures, and a sterile dressing is applied.
- A temporary or permanent fixation device might be utilized to maintain anatomical integrity.
Duration
The procedure typically takes 1 to 2 hours.
Setting
The procedure is performed in a hospital or outpatient surgical center.
Personnel
- Orthopedic or podiatric surgeon
- Anesthesiologist or anesthetist
- Surgical nurses and technicians
Risks and Complications
- Common risks: Infection, bleeding, swelling, pain
- Rare risks: Nerve damage, blood clots, delayed bone healing, recurrence of deformity
- Complications are managed with antibiotics, pain relief, and follow-up care.
Benefits
- Relief from chronic pain
- Improved foot function and mobility
- Correction of foot deformities
Recovery
- Post-operative care includes keeping the foot elevated and applying ice to reduce swelling.
- Pain management via prescribed medication
- The patient will need to avoid putting weight on the foot and may require crutches or a walker.
- Sutures are typically removed in 1-2 weeks during a follow-up appointment.
- Full recovery and return to normal activities can take several weeks to months.
Alternatives
- Conservative treatments: Orthotics, physical therapy, medications
- Less invasive surgical options: Bunionectomy, osteotomy
- Pros and cons vary depending on severity and specific patient conditions.
Patient Experience
During the procedure, patients under sedation should feel minimal discomfort. Post-procedure, there may be significant pain and swelling that can be managed with medication. Mobility will be limited initially, but physical therapy can aid in recovery.