Name of the Procedure:

Osteotomy, with or without lengthening, shortening, or angular correction, metatarsal; first metatarsal with autograft (other than first toe)

Summary

In layman's terms, this surgical procedure involves cutting and realigning the first metatarsal bone in the foot. It may include lengthening, shortening, or correcting the bone's angle and includes using a small bone graft from the patient (autograft). This helps improve foot function or appearance and addresses certain deformities or conditions.

Purpose

The procedure addresses deformities or injuries of the first metatarsal bone (other than the first toe). It aims to correct issues such as misalignment, improper length, or angular deformities to restore normal function and alleviate pain.

Indications

• Painful bunions or hallux valgus
• Metatarsus adductus (foot bones curve inward)
• Metatarsalgia (pain in the ball of the foot)
• Fractures or bone injuries not healing properly
• Arthritis or other degenerative joint diseases affecting the first metatarsal
• Severe foot deformities impacting mobility

Preparation

• Fasting for 8-12 hours before the procedure if general anesthesia is used.
• Stopping certain medications like blood thinners, as instructed by the doctor.
• Preoperative imaging, such as X-rays or MRI, to assess the metatarsal's condition and plan the surgery.

Procedure Description

1. The patient is given either general anesthesia or local anesthesia with sedation.
2. An incision is made near the first metatarsal bone.
3. The surgeon cuts the bone to realign, lengthen, or shorten it, and may correct its angle.
4. An autograft (bone taken from another part of the patient's body) is placed at the site if necessary to aid healing and bone integrity.
5. The bone is fixed in the new position using screws, plates, or other fixation devices.
6. The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is performed in a hospital or an outpatient surgical center.

Personnel

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

Risks and Complications

• Infection at the surgical site
• Blood clots
• Nerve damage, causing numbness or tingling
• Non-union or delayed healing of the bone
• Pain, swelling, or stiffness in the foot
• Adverse reactions to anesthesia

Benefits

• Reduced pain and improved foot function
• Correction of bone deformities
• Improved ability to walk properly
• Enhanced aesthetic appearance of the foot

Recovery

• Initial immobilization with a cast or boot to protect the foot
• Instructions on weight-bearing restrictions (often non-weight-bearing for several weeks)
• Pain management with prescribed medications
• Follow-up appointments to monitor healing
• Physical therapy exercises to improve strength and mobility
• Full recovery typically takes a few months, with complete bone healing taking up to a year.

Alternatives

• Non-surgical options like orthotic devices, physical therapy, or medications to manage symptoms
• Minimally invasive procedures, if suitable
• Arthrodesis (joint fusion) or other surgical techniques, depending on the condition's severity

Patient Experience

During the procedure, the patient will be under anesthesia and should not experience pain. Post-surgery, some discomfort and pain are expected, which can be managed with pain medications. Swelling, bruising, and limited mobility are common initially. Patients should follow care instructions closely to ensure proper healing and avoid complications.