Name of the Procedure:

Ostectomy, partial, exostectomy, or condylectomy, metatarsal head
Common name(s): Partial Ostectomy, Exostectomy, Condylectomy

Summary

This is a surgical procedure performed to remove part of the bone (ostectomy) or an abnormal bone growth (exostectomy) from the head of the metatarsal bone. It aims to alleviate pain and improve foot function.

Purpose

Medical conditions addressed:
This procedure primarily addresses painful conditions caused by bone deformities or growths on the metatarsal heads.

Goals/Expected outcomes:
The procedure aims to relieve pain, correct bone deformities, and improve the patient's ability to walk and bear weight on the foot.

Indications

Symptoms/Conditions:

• Chronic pain in the forefoot
• Difficulty walking due to bone deformity
• Presence of bony protrusions (exostoses) that cause discomfort

Patient Criteria:

• Patients with confirmed bone deformities or exostoses through imaging studies.
• Individuals who have not responded to conservative treatments like orthotics or physical therapy.

Preparation

Pre-procedure instructions:

• Fasting for 8 hours before the procedure, if general anesthesia is used.

• Adjustment or discontinuation of certain medications as directed by the physician.

  Diagnostic tests/Assessments:

• X-rays or other imaging tests to confirm the extent and location of the bone deformity.
• Pre-surgical blood tests and health assessments to ensure patient fitness for surgery.

Procedure Description

1. Anesthesia: The procedure can be performed under local, regional, or general anesthesia based on patient and surgeon preference.
2. Incision: A small incision is made over the affected metatarsal head.
3. Bone Removal: Using specialized surgical tools, the surgeon carefully removes the targeted portion of the metatarsal head.
4. Smoothing & Shaping: The remaining bone may be smoothed and shaped to ensure proper foot function and to avoid future discomfort.
5. Closure: The incision is closed with sutures, and a sterile dressing is applied.

Tools/Technology Used:

• Surgical blade, bone saw, bone rasp/file, suture materials

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and number of metatarsal heads involved.

Setting

This procedure is commonly performed in a hospital surgical suite or an outpatient surgical center.

Personnel

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

Risks and Complications

Common Risks:

• Infection at the surgical site
• Bleeding or hematoma formation
• Swelling and bruising

Rare Complications:

• Nerve damage leading to numbness or loss of sensation
• Poor wound healing or scarring
• Recurrence of the bone deformity

Benefits

Expected Benefits:

• Reduction or elimination of pain
• Improved foot function and mobility
• Enhanced quality of life

Timeline for Benefits:
Patients may start noticing an improvement in symptoms within a few weeks, with full benefits typically realized within 3 to 6 months after surgery.

Recovery

Post-procedure Care:

• Keeping the foot elevated to reduce swelling
• Keeping the surgical site clean and dry

Recovery Time:

• Initial recovery period is about 2 to 4 weeks, with limited weight-bearing activities.
• Full recovery may take up to 6 months.

Restrictions and Follow-up:

• Avoid high-impact activities until fully healed.
• Regular follow-up appointments to monitor healing.

Alternatives

Other Treatment Options:

• Orthotic devices to alleviate pain and provide support
• Physical therapy to strengthen surrounding muscles
• Medications for pain and inflammation

Comparison of Alternatives:

• Non-surgical options may provide temporary relief but may not correct the underlying issue.
• Surgery offers a more permanent solution but comes with inherent surgical risks.

Patient Experience

During the Procedure:

• If under local anesthesia, the patient might feel pressure but should not feel pain.
• General anesthesia will result in the patient being asleep and feeling no pain during the procedure.

After the Procedure:

• Patients may experience mild to moderate pain, which can be managed with prescribed pain medications.
• Swelling and stiffness are common but diminish over time.
• The use of crutches or a walker may be necessary initially to avoid putting weight on the affected foot.