Lesser Metatarsal Surgery

Lesser metatarsal osteotomy, often carried out alongside bunion surgery, is performed to treat toe deformities of the metatarsals (the long bones in the foot that connect the ankle to the toes) or metatarsalgia which is a form of rheumatoid arthritis.

Each foot has five metatarsals (long, tubular shaped bones).  The lesser metatarsals are the bones that connect your toes (except the first/big toe) and form the ball of your foot. 

An osteotomy is a cut made in the bone, similar to breaking the bone in a meticulous way.  A lesser metatarsal shortening osteotomy changes the pressure distribution under the ball of the foot, relieving pain.  It can also be performed to reposition a chronically dislocated toe.

The aim of lesser metatarsal surgery is to reduce pain and deformity, improve pressure distribution in the ball of the foot, reduce callus/corn formation and improve toe alignment where possible.

What Causes Deformities?

Mallet, hammer and claw toe and adductovarus are all types of deformity of the small toes, with the description changing, depending on which toes are bent.  It is very difficult to clinically differentiate between the hammer toe and claw toe, so they are frequently used interchangeably.

Although the conditions usually stem from muscle imbalance, ill-fitting shoes often worsen them, along with socks that restrict the toes.  This often occurs in both feet. Deformity of the toe can also be caused by an injury, genetic conditions (sometimes from birth) and arthritis.

If you experience issues with your big toe, such as a bunion, you may develop problems with the second toe (or more) as the bunion will cause you to put more weight on the smaller toes than normal.

Metatarsalgia (a form or rheumatoid arthritis) is a condition where the ball of your foot becomes painful and inflamed.  This can develop as a result of participation in activities such as running or jumping as well as ill-fitting shoes and foot deformities.

What are the Symptoms?

Symptoms include:

• Pain on top of the toes as they rub on shoes
• Developing a callus or hard lump of skin on the knuckle of the toe
• Pain experienced in the ball of your foot
• Swelling, redness and stiffness in the affected toes
• Increased pain when standing, running, walking or flexing your feet
• A sharp shooting pain, numbness, or a prickly sensation in your toes

Treatment

Lesser metatarsal surgery is an option if non-surgical methods have failed to relieve your pain.

This surgical technique is used to distribute pressure across the ball of your foot, alongside correcting the angles of your toes and any dislocation.  Other less invasive options may be more suitable depending on the level of symptoms and deformity.  However, when the toe is dislocated, the deformity is generally treated with a metatarsal shortening osteotomy, because simply straightening the toe can decrease blood flow, resulting in complications.

Another reason for undergoing lesser metatarsal surgery is to relive pressure from under a metatarsal head.  This is often indicated by a callus and pain or discomfort in the ball of the foot.

Lesser metatarsal surgery is carried out as a day case procedure, taking approximately 30 – 45 minutes to perform.  The procedure is performed under local anaesthetic and includes an injection into the foot to ease pain following surgery.  You will be awake during the surgery and can eat normally and take prescribed medication on the day of the operation.

The procedure involves making one incision (cut), approximately two inches long, on the top of the foot around the area where the toe meets the foot.  If you need more than one metatarsal operated on then more than one incision may be necessary.  The bone is cut and shifted, effectively shortening it marginally to ease the pain under the foot or toe.  The osteotomy is then held in position with a small metal screw or pin and the skin is closed.  Other soft tissue procedures are often performed at the same time to correct deformities of the toe.

Post-Operative Recovery

Following lesser metatarsal surgery, a padded dressing is placed around the foot.  You will only be allowed to place weight on the heel and may be given a hard soled shoe or boot to help protect the surgical site.

You will be given instructions on how to keep the dressing clean.  You can have a shower or a bath as long as you keep the dressing dry; try using a plastic bag to cover it.  It is important to keep your foot elevated as much as possible to reduce swelling, as otherwise it can lead to complications with wound healing.

A follow-up appointment will likely be made 1 – 2 weeks following surgery.  The dressing will be changed and when the skin is healed, the stitches are then removed.  At 4 – 6 weeks, you can start to bear weight on your foot as much as you can tolerate.  You will be referred to a physiotherapist who will provide range of motion exercises and a personalised rehabilitation programme.

It is important to avoid smoking and taking anti-inflammatory medications as this can affect the healing process and delay, or in some cases, prevent the bone from fusing together.

Healing and post-operative programmes vary from person to person; however, you should be able to resume your normal activities 12 weeks following your procedure.

Risks and Complications

As with all invasive surgery, there is a risk of complications. These include:

• Reaction to the anaesthetic
• Infection
• Damage to nerves and blood vessels
• Bleeding or blood clots

Specific complications to lesser metatarsal surgery include:

• Continued pain. This typically occurs when the bone fails to heal after it has been cut. You may require an additional procedure to get the bone to heal correctly to eliminate the pain
• Excessive scarring
• Recurrence of the deformity
• Toe stiffness – this should improve through physiotherapy
• Deep vein thrombosis (DVT). You may be given blood-thinning medication following surgery if you are at a higher risk of DVT (where a blood clot forms in a vein in the leg)

Outlook 

You should notice an improvement in pain once the toe has healed, generally around 6 weeks following surgery.  In most cases, you will be able to return to a moderate level of activity within 3 months and full recovery and normal activities by 12 months.  You may experience mild swelling and stiffness in the toe for up to a year following surgery.

Need Help?

At One Healthcare we can book you in to see a specialist Podiatric or Orthopaedic surgeon, usually within 48 hours, for an initial consultation.  Lesser metatarsal surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.

You can use your private medical insurance or pay for your Lesser Metatarsal Surgery treatment. We offer competitive, fixed price packages as well as the ability to spread the cost of your treatment over a number of months. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.

Why One Healthcare

• Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
• Fast access to diagnostics including MRI, X-ray and Ultrasound
• Private, spacious, en-suite rooms
• Specialist Physiotherapy and nursing teams
• Little or no waiting time
• ‘Ultra clean air’ theatres
• Freshly prepared food
• Calm, dignified experience

Contact us and find out more

If you live in and around the Kent area and would like to visit our One Ashford Hospital please click here

If you are based in and around Hertfordshire and would like to visit the One Hatfield Hospital please click here.