Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; multiple (eg, Swanson type cavus foot procedure)
CPT4 code
Name of the Procedure:
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; multiple (e.g., Swanson type cavus foot procedure)
Summary
This surgical procedure involves cutting and reshaping one or more of the metatarsal bones in the foot. The goal is to correct deformities, such as high arches (cavus foot), by adjusting the length, alignment, or angle of the bones.
Purpose
The procedure addresses deformities in the metatarsal bones, commonly due to conditions like cavus foot. The primary goals are to alleviate pain, improve foot alignment, and enhance overall foot function and mobility.
Indications
- Persistent foot pain due to deformities or misalignment
- High arches (cavus foot)
- Difficulty walking or wearing shoes comfortably
- Non-responsive to conservative treatments like orthotics or physical therapy
- Progressive deformity
Preparation
- Patients may need to fast for a specific period before surgery.
- Pre-operative assessments including X-rays, MRI, or CT scans.
- Medication adjustments, especially if on blood thinners.
- Smoking cessation and optimized control of any underlying conditions like diabetes.
Procedure Description
- Anesthesia: Typically performed under general anesthesia.
- Incision: A surgical incision is made over the metatarsal bones.
- Cutting and Shaping: The surgeon cuts and repositions the bones to the desired length and angle.
- Fixation: Metal pins, screws, or plates may be used to secure the bones in their new position.
- Closure: The incision is closed with sutures, and the foot may be placed in a cast or boot.
Duration
The procedure typically takes 1-2 hours, depending on the complexity and the number of bones involved.
Setting
Performed in a hospital, outpatient clinic, or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurse
- Anesthesiologist
- Possibly a radiologic technologist for intraoperative imaging
Risks and Complications
- Infection
- Bleeding
- Nerve damage
- Poor bone healing or non-union
- Blood clots
- Need for additional surgeries
- Pain or persistent discomfort
Benefits
- Relief from pain caused by foot deformities
- Improved foot alignment and function
- Enhanced ability to walk and wear shoes comfortably
- Generally, benefits are noticeable within a few weeks after surgery, though full recovery may take months.
Recovery
- Post-procedure: Rest and elevation of the foot.
- Pain management: Medications prescribed as needed.
- Immobilization: Cast or boot for several weeks.
- Physical Therapy: May be needed to restore mobility and strength.
- Follow-up: Regular appointments to monitor healing and remove any hardware if necessary.
- Activity: Limited weight-bearing on the operated foot until cleared by the surgeon.
Alternatives
- Conservative treatments like orthotics, physical therapy, and medication.
- Less invasive procedures such as tendon transfers or joint fusions.
- Pros: Avoids surgical risks.
- Cons: Might not be as effective for severe deformities.
Patient Experience
- Pre-procedure anxiety is common; discuss with the healthcare team.
- Post-procedure: Pain and swelling managed with medication and ice.
- Immobilization might feel uncomfortable; crutches or a walker may be needed.
- Regular follow-ups to ensure proper healing and adjust treatment plans as needed.