Name of the Procedure:

Osteotomy, with or without lengthening, shortening, or angular correction, metatarsal; other than first metatarsal, each.

Summary

An osteotomy of the metatarsal is a surgical procedure where a bone in the foot other than the first metatarsal is cut to correct its length, angle, or shape. This can involve lengthening, shortening, or modifying the angle of the bone to address various foot deformities or issues.

Purpose

This procedure aims to correct deformities, improve foot function, relieve pain, and prevent further complications. It is often performed to address specific conditions like rheumatoid arthritis, traumatic injuries, or congenital defects affecting the foot.

Indications

Specific symptoms or conditions that warrant the procedure include:

• Chronic pain not relieved by conservative treatments
• Significant deformity or misalignment of the metatarsal bones
• Difficulty in walking or performing daily activities due to foot structure
• Conditions such as rheumatoid arthritis, fractures, or congenital deformities Patient criteria or factors that make the procedure appropriate include:
• Persistent symptoms despite non-surgical treatment options
• Diagnostic imaging confirming the need for corrective osteotomy
• Overall good health to withstand surgery and recovery

Preparation

• Patients may need to fast for 6-8 hours before surgery.
• Medication adjustments, such as stopping blood thinners, may be necessary.
• Preoperative blood tests, imaging studies (X-rays, MRI), and medical evaluations are typically performed.

Procedure Description

• The patient is typically under general or regional anesthesia.
• A surgical incision is made over the targeted metatarsal bone.
• The bone is cut (osteotomy) and carefully adjusted to the desired position.
  • This may involve lengthening, shortening, or changing the angle.
• Fixation devices such as screws, plates, or pins are used to stabilize the bone.
• The incision is closed with sutures, and a dressing is applied.
• Postoperative splinting or casting may be required to maintain bone alignment.

Duration

The procedure typically takes 1 to 2 hours, depending on its complexity and the level of correction needed.

Setting

Osteotomy of the metatarsal is usually performed in a hospital or outpatient surgical center equipped for orthopedic procedures.

Personnel

• Orthopedic surgeon specialized in foot surgery
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians

Risks and Complications

Common risks include:

• Infection
• Bleeding or blood clots
• Pain and swelling
• Nerve damage
• Stiffness or limited mobility in the foot

Rare complications might include:

• Nonunion or malunion of the bone
• Delayed healing
• Adverse reactions to anesthesia

Benefits

Expected benefits include:

• Relief from chronic pain
• Improved foot alignment and function
• Enhanced ability to walk and perform daily activities Benefits may be realized within weeks to months, depending on the healing process.

Recovery

Post-procedure care includes:

• Keeping the foot elevated and applying ice to reduce swelling
• Pain management with prescribed medications
• Wearing a cast or splint to maintain bone alignment
• Physical therapy to restore movement and strength Expected recovery time is typically 6 to 12 weeks, with gradual improvement in function. Follow-up appointments are necessary to monitor healing.

Alternatives

Other treatment options include:

• Non-surgical methods such as orthotic inserts, physical therapy, or medication
• Less invasive surgical procedures if applicable Pros and cons:
• Non-surgical options may offer relief without the risks of surgery but might not provide permanent correction.
• Other surgical options may vary in invasiveness and effectiveness.

Patient Experience

During the procedure:

• Patients will be under anesthesia and should not feel any pain. After the procedure:
• Expect discomfort, swelling, and limited mobility initially.
• Pain management strategies such as medications and ice packs will be utilized.
• Physical therapy and gradual weight-bearing will help in recovery and regaining functional use of the foot.