Name of the Procedure:

Metatarsectomy
Common name(s): Forefoot surgery, Metatarsal surgery, Metatarsal head resection
Technical/medical term: Metatarsectomy

Summary

Metatarsectomy is a surgical procedure aimed at relieving pain and correcting deformities associated with the metatarsal bones in the foot. The surgery involves the removal or realignment of portions of the metatarsal bones, typically to address conditions such as rheumatoid arthritis, severe bunions, or chronic forefoot pain.

Purpose

Medical Conditions Addressed:

• Rheumatoid arthritis
• Severe bunions (hallux valgus)
• Chronic forefoot pain (metatarsalgia)
• Foot deformities

Goals/Expected Outcomes:

• Alleviation of pain
• Correction of foot deformities
• Improvement in foot function
• Enhanced quality of life and mobility

Indications

Symptoms/Conditions:

• Persistent forefoot pain not responsive to conservative treatments
• Significant deformities of the toes or metatarsal bones
• Difficulty in walking or wearing shoes due to bone misalignment
• Inflammatory conditions affecting the metatarsal bones

Patient Criteria:

• Adults with chronic forefoot conditions
• Patients where non-surgical treatments have failed
• Individuals with deformities impacting daily activities

Preparation

Pre-procedure Instructions:

• Fasting for 6-8 hours prior to surgery
• Adjustment or temporary discontinuation of certain medications (e.g., blood thinners)
• Preoperative physical examination and medical history review

Diagnostic Tests/Assessments:

• Foot X-rays or MRI to evaluate bone and joint condition
• Blood tests to ensure readiness for surgery

Procedure Description

1. Anesthesia: Administered general or local anesthesia.
2. Incision: A surgical cut is made over the affected metatarsal bone(s).
3. Bone Resection/Realignment: Removal or reshaping of portions of the metatarsal bone.
4. Soft Tissue Adjustment: Repair or release of surrounding tendons and soft tissues as needed.
5. Closure: The incision is closed with stitches, and the foot is bandaged.

Tools/Equipment:

• Scalpel
• Bone saw or burr
• Suture materials

Anesthesia or Sedation Details:

• General anesthesia for total unconsciousness or local anesthesia with sedation for numbness and drowsiness.

Duration

The procedure typically takes 1 to 2 hours, depending on the extent of the surgery.

Setting

Metatarsectomy is usually performed in an outpatient surgical center or hospital operating room.

Personnel

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

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Swelling

Rare Complications:

• Nerve damage
• Blood clots
• Nonunion or delayed healing of bones

Management:

• Antibiotics for infection
• Pain medication
• Physical therapy

Benefits

Expected Benefits:

• Pain relief
• Improved foot alignment
• Enhanced ability to walk and wear shoes comfortably

Timeline for Benefits:

• Most patients begin to notice improvement within a few weeks, with full benefits realized over several months.

Recovery

Post-Procedure Care:

• Elevation of the foot to reduce swelling
• Ice application
• Pain management with prescribed medications

Recovery Time:

• Initial recovery: 6-8 weeks
• Full recovery: Several months

Restrictions/Follow-Up:

• Avoid bearing weight on the foot for several weeks
• Follow-up appointments for wound checks and X-rays

Alternatives

Other Treatment Options:

• Conservative treatments: Orthotic devices, physical therapy, corticosteroid injections
• Less invasive surgical options Pros and Cons:
• Conservative treatments are less invasive but may not provide long-term relief.
• Alternative surgeries may not address all deformities or chronic pain issues as effectively.

Patient Experience

During the procedure, patients will either be asleep or numbed. Post-operatively, patients might experience discomfort, swelling, and the need for pain management. Following instructions on rest, elevation, and limited activity is crucial for optimal recovery. Regular check-ups ensure proper healing and address any concerns.