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Metatarsalgia – Surgery

What operations can be done?

An operation may be considered if simple treatments do not improve the pain in your foot or the position of the toes. An operation is always optional. How much pain you have in your foot will help you decide whether you need an operation. 

Weil osteotomy

A Weil osteotomy is done to shorted the metatarsal bone slightly. This reduces the load on the metatarsal and so reduces forefoot pain and also allows correction of toe deformity. This is done through a small incision on the top of the foot. The bone is cut with a fine precision saw and fixed with a buried screw to allow stability and rapid mobilisation. 

Plantar plate repair

The plantar plate is the ligament at the base of the second toe which holds the toe in line. If a rupture of the plantar plate is not treated rapidly it can lead the toe to hammer out of shape. The plantar plate ligament can be repaired with a small operation carried out through the top of the foot. A Weil osteotomy is often carried out at the same time. 

Operations to fix the small toes

Open or keyhole surgery

With open surgery there is a cut on the top of the toe. Sometimes the tendons need to be lengthened. Sometimes a part or all of the knuckle joint is taken out to straighten the toe. There may be a small cut under the toe for lengthening of the tendon or transfer of other tendons. Sometimes there is a small metal wire down the length of the toe. If this is required it will be in the toe for 6 weeks until the bone heals. 

In many cases the bone at the base of the toe a Weil osteotomy is performed. This allows the toe to sit in the correct position and relieves the pain in the ball of the foot.

Keyhole surgery (distal minimally invasive metatarsal osteotomy – DMMO – and lesser toe correction) can be very effective in correcting problems in the lesser toes for many people. Keyhole surgery is done through cuts of a few millimetres with the surgeon using x-rays to see that the bone is reset correctly. With keyhole surgery on the lesser toes there is no need for screws or pins in the foot. 

The surgery recommended will vary from one patient to the next depending on your situation. Our surgeons will discuss the different options with you in the clinic.

For people with problems in both feet there is the option of having surgery to both feet at the same time. Most people having surgery to only one foot can be treated as a day case. People having surgery to both feet at the same time sometimes stay in hospital overnight.

What does the anaesthetic involve?

You will meet the anaesthetist before the operation so that they can discuss which anaesthetic will be best for you. The operation is usually done under general anaesthetic. A nerve block to numb the toes helps with pain relief immediately after the operation. 

What happens after the operation?

After the operation you will have a bandage on your foot for about two weeks. You will wear either a blue shoe (figure 2) or a forefoot off-loading shoe (figure 3) to walk. 

You are more comfortable if you elevate your foot as much as possible on a footstool, recliner chair or sofa.

When can I return to work?

You can return to desk work at around 2 weeks after your operation. Remember to sit with your foot propped up. If you are on your feet for longer periods it may be 6 weeks before you are comfortable enough to get back to work.

Orthopaedic clinic

You will have an outpatient clinic appointment about 2 weeks after your operation. Dressings will be changed and the wound checked. Stitches are usually dissolvable and so only need trimming back in clinic. If you have wires in your toes they will be removed in the outpatient clinic around 4 to 6 weeks after the operation.

What problems might there be after the operation?

Any operation has risks. These risks are higher in patients who smoke, are on steroid medication or have diabetes. After this operation problems can be:

  • Ongoing pain
  • Infection
  • Reduced blood circulation in the toe requiring early removal of the wire
  • Blood clots in the leg or lungs
  • Swelling in the toe that does not settle
  • Stiffness in the toe joints
  • Floppy toes
  • Return of the deformity
  • Breakage of wires or other metal used in the operation
  • Nerve related pain

 

Interested in treatment options?

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