Metatarsal Osteotomy Surgery
Metatarsalgia is a term that is used to refer to pain underneath the bones of the ball of the foot, the metatarsal heads. Usually the term is used in reference to the 2nd, 3rd, and 4th metatarsals.
In the “normal” or ideal foot, the 2nd-4th metatarsals create and arch along the frontal plane. The frontal plane is indicated by the cross section pointed to by the arrow in the diagram below.
The arch these metatarsals form allows for the primary weight bearing bones to be the 1st and the 5th metatarsals.
When the foot structure is such that the 2nd, 3rd or 4th metatarsals are positioned in a downward manner, and the arch is convex rather than concave, pressure is abnormally placed on the middle metatarsals (2-4) and pain can be elicited.
Another scenario the 2nd, 3rd and 4th metatarsals can be a problem is when these bones are longer than the 1st metatarsal, once again creating a situation where the pressure on the 2nd, 3rd and 4th metatarsals is greater than usual.
The Procedure
Metatarsal osteotomy is commonly referred to as a Weil Osteotomy. It involves a few steps. The first step is dissection and exposure of the metatarsal head. This step requires an incision on the top foot over the metatarsal phalangeal joint. This incision is then deepened to the level of the joint capsule. This is a layer of ligamentous tissue that is thick and covers the entire joint. The capsule is incised to expose the joint (it will be repaired later). The bone is cut at an oblique angle and shifted backward and upward to reduce the pressure on the bottom of the foot. The osteotomy is then fixated with a compressive screw.
A tendon transfer, bone or tissue graft maybe performed in addition to the basic steps to provide the best result for your particular condition.
During the procedure, if your surgeon notices that extra steps are required to improve the outcome of the procedure, these steps will be performed in addition to the planned procedure. These can include a tendon transfer, bone or tissue graft.