Name of the Procedure:

Osteotomy, tarsal bones, other than calcaneus or talus; with autograft (includes obtaining graft) (e.g., Fowler type)

Summary

An osteotomy is a surgical procedure where a bone is cut to shorten, lengthen, or change its alignment. This specific type of osteotomy involves the tarsal bones (excluding the calcaneus or talus) and includes the use of an autograft, which means bone material is taken from another part of the patient’s body to assist in the healing process.

Purpose

This procedure is typically done to correct deformities, alleviate pain, or manage conditions related to abnormal positioning or malfunction of the tarsal bones in the foot. The goals are to restore proper alignment, improve function, and reduce discomfort.

Indications

• Persistent pain or dysfunction in the foot despite conservative treatments.
• Deformities of the tarsal bones causing significant functional impairment.
• Specific conditions such as flatfoot (pes planus) or high arches (pes cavus).
• Corrective needs following injury or for managing congenital or developmental abnormalities.

Preparation

• Patients may need to fast for 6-12 hours before surgery.
• Adjustment or cessation of certain medications may be required.
• Diagnostic imaging tests like X-rays, CT scans, or MRIs may be necessary to plan the surgery.

Procedure Description

1. The patient is placed under general anesthesia or regional anesthesia with sedation.
2. An incision is made over the targeted area of the tarsal bones.
3. The surgeon cuts the bone (osteotomy) to achieve the desired realignment.
4. A bone graft is harvested from another part of the patient’s body, commonly the pelvis.
5. The autograft is placed in the osteotomy site to promote proper healing.
6. Fixation devices such as screws or plates may be used to hold the bones in place.
7. The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes between 1 to 2 hours, depending on complexity.

Setting

This surgery is typically performed in a hospital or outpatient surgical center.

Personnel

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

Risks and Complications

• Infection at the surgical or graft site
• Nerve damage leading to numbness or tingling
• Non-union or delayed healing of the osteotomy
• Blood clots or deep vein thrombosis (DVT)
• Adverse reactions to anesthesia

Benefits

• Reduction or elimination of pain
• Improved foot alignment and function
• Enhanced ability to walk and perform daily activities without discomfort
• Long-term correction of foot deformities

Recovery

• Patients generally need to keep weight off the affected foot for several weeks.
• A cast or brace may be required to immobilize the foot.
• Physical therapy may be recommended to restore strength and mobility.
• Follow-up appointments are necessary to monitor healing and progression.
• Full recovery can take several months, with gradual return to normal activities.

Alternatives

• Orthotic devices or custom insoles to provide support and alleviate symptoms.
• Physical therapy to strengthen and stabilize the foot.
• Minimally invasive treatments like injections.
• In some cases, other types of surgery may be considered, depending on the specific condition and its severity.

Patient Experience

• Patients may wake up with a cast or brace on their foot and a possible sensation of swelling and discomfort.
• Pain can be managed with prescribed medications.
• Elevating the foot and applying ice may help reduce swelling.
• It is important to follow all post-operative instructions carefully for optimal recovery.