What are the indications for this surgery?
This surgery is considered when you have intractable pain in the ball of the foot 'metatarsalgia' or when there is deformity of the toe. The metatarsalgia in these cases may may be secondary to a relatively long metatarsal leading to increased point-loading and callus or corn formation under the ball of the foot. Toe deformities can accentuate the pain further especially if the toe is out of joint or the deformity is severe. Should conservative management not help, then surgery would be advised.
Xray of patient with severe toe deformities complaining of metatarsalgia from relatively long 2nd to 4th metatarsals in comparison to big toe. 'Blue line' shows abnormal parabolica of metatarsals
How is the operation done?
You will be admitted on the day of operation and this daycase procedure is routinely performed under a general anaesthetic. Occasionally a spinal anaesthetic may be considered. The operation takes about 30min to 1hour depending on whether any additional planned procedures are undertaken.
A small incision (~3cm) is made over the dorsum (top) of the forefoot. The involved metatarsophalangeal joint (MTPJ) is exposed and the metatarsal is cut using a micro-saw. The bone fragment is moved to the desired position and then secured with a small 2mm diameter screw. Should the toe need further straightening, the toe will be corrected and may be secured with a small wire that is usually left proud at the tip of the toe (this will be removed in clinic approximately 6 weeks following the procedure).
The wounds are closed with dissolvable stitches. Your foot would dressed in a bandage and supported in an orthopaedic shoe for approximately 6 weeks. You will be allowed to immediately weight-bear with the sandal following the procedure.
Xray demonstrating correction of toe deformities through (a) Multiple Weil's osteotomies of 2nd - 4th metatarsals fixed with 2mm screws & (b) Big toe fusion using plate. 'Blue line' showing restoration of metatarsal parabolica.
Aftercare and FAQs
It is important to keep the leg elevated as much as possible especially for the first 2 weeks. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours. Your fist clinic follow-up is usually 12 to 14 days after surgery.
Wound care – The dressing should be kept dry. At yours first clinic appointment, would inspection and suture removal would be undertaken.
Work - If you have a sedentary job you should be able to return to work within 2 weeks (if you can arrange safe transport). If your job is physical, you may need to stay off work for 6 weeks.
Driving - You will not be able to drive for 6 weeks following surgery. However, if you drive an Automatic and it was your LEFT side that was operated on; then you may start short drives 2 weeks following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.
Flying after surgery - It is generally recommended to wait at least four to six weeks to fly after any lower limb surgery. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.
Sport - You should avoid sport for at least 2 months from surgery. When to return to sport after that depends on the speed of recovery and type of sport.
What are the surgical risks?
Nerve damage — causing numbness and painful scar
Deep vein thrombosis (DVT) and pulmonary embolism (PE) — blood clots in the vein or lungs
Delayed bone healing
Prolonged toe swelling and stiffness
Slightly 'high-riding' toe
It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.