28306 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal

Name of the Procedure:

Osteotomy of the First Metatarsal (with or without lengthening, shortening, or angular correction)

Summary

An osteotomy of the first metatarsal involves surgically cutting and realigning the first bone in the forefoot. This procedure can correct deformities, adjust bone length, or change the bone's angle to improve foot function and relieve pain.

Purpose

The procedure addresses structural deformities or dysfunctions of the first metatarsal, often associated with conditions like bunions or hallux valgus. The goal is to correct bone alignment, relieve pain, and restore normal foot mechanics.

Indications

• Severe bunions (hallux valgus)
• Metatarsalgia (pain in the ball of the foot)
• Foot deformities affecting the first metatarsal
• Failed conservative treatments (e.g., orthotics, medications)
• Chronic pain or dysfunction affecting mobility

Preparation

• Pre-operative fasting as directed
• Adjustments to current medications, especially blood thinners
• Diagnostic imaging (X-rays, MRI) to assess the deformity
• Medical clearance and routine blood work

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A small incision is made over the first metatarsal.
3. Bone Cutting: The first metatarsal bone is precisely cut.
4. Realignment: The bone segments are realigned to correct deformity, length, or angle.
5. Fixation: Screws, pins, or plates are used to secure the bone in its new position.
6. Closing: The incision is closed with sutures, and the area is bandaged.

Tools/Equipment:

• Surgical saw or osteotome
• Fixation devices (screws, plates, pins)
• Imaging tools (fluoroscopy)

Duration

The procedure generally lasts about 1-2 hours.

Setting

Typically performed in a hospital or an outpatient surgical center.

Personnel

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

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Nonunion or malunion of the bone
• Blood clots
• Prolonged pain or stiffness

Benefits

• Pain relief in the affected foot
• Improved foot alignment and function
• Better mobility and quality of life
• Prevention of future complications related to foot deformities

Recovery

• Initial post-operative immobilization (cast or boot)
• Instructions on weight-bearing and use of crutches
• Pain management with medications
• Physical therapy to restore strength and flexibility
• Follow-up visits to monitor healing
• Full recovery typically within 6-12 weeks, activity restrictions may apply

Alternatives

• Non-surgical treatments: orthotics, physical therapy, pain medications
• Other surgical options: arthrodesis (fusion), exostectomy (removal of bone spurs)
• Pros and Cons: Non-surgical methods may provide symptom relief but not structural correction, other surgeries may have different risks or benefits

Patient Experience

• During the procedure: Under anesthesia, the patient will not feel pain.
• After the procedure: Some discomfort and swelling are common; pain management measures include medications and ice application.
• Emotional Support: Clear communication with the surgical team and realistic expectations can help reduce anxiety.