28114 Ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal (eg, Clayton type procedure)

Name of the Procedure:

Ostectomy, Complete Excision; All Metatarsal Heads, with Partial Proximal Phalangectomy, Excluding First Metatarsal (Clayton Type Procedure)

Summary

The ostectomy procedure involves the surgical removal of the entire metatarsal heads and part of the proximal phalanges in the foot, excluding the first metatarsal. This is usually done to alleviate severe pain and deformity caused by various foot conditions.

Purpose

This procedure is performed to address severe arthritis, deformities, or damage to the metatarsal heads in the foot. The goal is to alleviate pain, improve foot function, and enhance the patient's overall quality of life.

Indications

• Severe arthritis or osteoarthritis of the metatarsal joints, excluding the big toe
• Painful foot deformities, such as claw toes or hammer toes
• Chronic foot pain not responsive to conservative treatments
• Conditions like rheumatoid arthritis affecting the metatarsals

Preparation

• The patient may be instructed to fast for a specified period before the surgery.
• Any medications, especially blood thinners, may need to be adjusted.
• Pre-surgical evaluations, such as X-rays or MRI scans, will be conducted to assess the foot's condition.
• A thorough medical history and physical examination will be performed.

Procedure Description

1. The patient is placed under general anesthesia or regional anesthesia with sedation.
2. An incision is made over the metatarsal heads.
3. The surgeon carefully excises the metatarsal heads and the affected portions of the proximal phalanges.
4. Any necessary adjustments to the surrounding soft tissue are made to ensure proper alignment and function.
5. The incision is then closed with sutures, and the foot is bandaged.

Equipment used may include scalpels, bone saws, and surgical clamps.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

This surgery is usually performed in a hospital or surgical center operating room.

Personnel

A team of healthcare professionals involved includes:

• Orthopedic surgeon or podiatric surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Blood clots
• Nerve damage
• Persistent pain or discomfort
• Delayed wound healing
• Development of new foot deformities

Benefits

• Significant reduction in foot pain
• Improved foot function and mobility
• Enhanced quality of life and ability to perform daily activities

Recovery

• Post-procedure, patients will need to avoid putting weight on the foot for several weeks.
• Pain management may include prescription medications and ice packs.
• Follow-up appointments will be scheduled to monitor healing.
• Physical therapy may be recommended to regain strength and mobility.
• Full recovery usually takes several months.

Alternatives

• Conservative treatments such as orthotic devices, physical therapy, and anti-inflammatory medications.

• Less invasive surgical procedures like metatarsal osteotomies.

  Pros of alternatives include less recovery time and fewer risks; however, they may not be as effective for severe conditions.

Patient Experience

• During the procedure, the patient will be under anesthesia and will not feel pain.
• Post-surgery, patients may experience swelling, bruising, and discomfort.
• Pain management will be provided, which may include medications and supportive measures like elevation of the foot.