Metatarsalgia Surgery - Operation Guide

In most cases, metatarsalgia doesn’t need any surgical intervention; with rehabilitation, the foot should heal. However, in extreme cases, your podiatrist may recommend surgery to treat metatarsalgia. For example, if inflammation does not subside and there is severe pain, it may mean the metatarsal bones need to be restructured.

Thankfully, studies reveal about a 97% success rate with metatarsalgia surgery. But how do you know when surgery is necessary, and what’s the procedure of metatarsalgia surgery?

Is Surgery Necessary?

Surgery is the last resort in most metatarsalgia cases, as most patients can control and even eliminate their symptoms without surgical intervention. More so, the main factor in non-surgical treatment methods for metatarsalgia is footwear.

More often than not, switching to comfortable, well-fitting shoes with the proper support, and resting the feet will resolve ball of the foot pain.

However, when non-surgical management does not work, then surgery is recommended. A foot and ankle orthopaedic physician may need to perform a realignment of the metatarsal bones during metatarsalgia surgery.

Possible Risks and Complications

Metatarsalgia surgical operations do not always have a predictable outcome and they don’t always work.

The potential risks and complications following a metatarsalgia surgery include:

• Prolonged Swelling – This can last for at least six months and can occur in 1 in 500 procedures.
• Scarring – A metatarsalgia procedure may leave you with a thick or sensitive scar.
• Irritation – The surgery typically involves internal fixation with screws and plates. They are not usually removed unless they cause a problem, which can occur in about 10% of cases.
• Hematoma – There can be a painful collection of blood under the skin, increasing the risk of infections and requiring correction surgery.
• Reaction to Painkillers – 1 in 50 patients reports a negative reaction to the post-operative painkillers used, such as codeine.
• Osteomyelitis – The procedure may cause an infection of the bone, which can lead to amputation in severe cases.
• Blood Clot – 3 in 1,000 patients may experience deep vein thrombosis, where blood clot travels to the lung, resulting in a life-threatening condition.
• Other complications in lesser surgeries include transferring skin lesions to an adjacent metatarsal head, scar contracture, continued pain, floating toe, and fracture.

The Surgery Procedure

Before starting any surgical procedure, you should be aware of the procedure – how to prepare for it, the types of operations available to you and what they involve.

Preparing for the Operation

Metatarsalgia surgery starts with pre-operative screening, which your healthcare provider will use to determine whether surgery is necessary or not. It's essential that you don’t withhold any part of your medical history and ask questions where necessary.

Using a clinical examination and the information you provide, your doctor will provide a diagnosis. They will examine your foot, conducting various tests to pinpoint the inflammation and damage points and provide the best possible treatment plan.

Also, they may decide to perform X-rays, an ultrasound or an MRI to diagnose disorders arising from any biochemical imbalance. Furthermore, you may be given diagnostic injections of a local anaesthetic to determine where exactly the pain is coming from.

Types of Metatarsalgia Operations

The type of metatarsalgia operation conducted will depend on the severity of your condition and availability.

Some common metatarsalgia operations include:

• Weil Ssteotomy – A procedure where the metatarsal bone is shortened slightly to reduce the load on it. This reduces the pain and also enables correction of toe deformity, allowing stability and rapid mobilisation.
• Plantar Plate Repair – This surgery is best if there is a rupture of the plantar plate. This plantar plate repair is usually done alongside a Weil osteotomy.
• Open Surgery – This can also be done to fix the small toes and is usually done when the tendons need to be lengthened. Otherwise, keyhole surgery can be done to correct problems in the lesser toes; it is very effective and requires no screws or pins.

How long will the operation take?

Metatarsalgia surgery is usually conducted using minimally invasive techniques with X-ray guidance. The operation typically lasts about 30 to 45 minutes; it is usually conducted as a day-case procedure.

Will it be done under anaesthesia?

Metatarsalgia surgery is performed under local anaesthetic; the physician will inject it into the foot to ease pain post-op. Since it's usually done under local anaesthesia, you’re going to be awake throughout the surgery.

Then, depending on the type of surgery, the metatarsal bone is cut or shaved, realigned, and held in place with plates and screws.

After the Procedure

Some common questions and considerations to take after metatarsalgia surgery include:

Will I need to use crutches?

You will need to use crutches after your metatarsalgia surgery along with an Aircast walking boot for approximately six weeks. The essence of the crutches is to limit the weight on the foot while wearing the cast.

You should use the crutches until your healthcare provider has reviewed your postoperative x-ray.

Will I need medication?

Your physician will provide you with pain medications after a metatarsalgia surgery. You should take them immediately after you get home and continue for at least three days or until your first post-op visit to the clinic.

Also, you may be given blood-thinning medication if you are at a higher risk of deep vein thrombosis.

What can I do?

• Travel home by car and keep the foot elevated throughout the ride.
• Wear your Aircast walking boot at all times when moving around, and keep your foot elevated as much as possible.
• After the metatarsalgia surgery, rest with the leg elevated for the first two to four days.
• Exercise caution when taking a shower to avoid getting the dressing wet.
• What should I avoid doing?
• Avoid tampering with the dressing, and do not get them wet
• Avoid taking anti-inflammatory medications as they can delay the healing process
• Avoid smoking

What is the recovery time?

Two weeks post-op, the dressings will be removed, and the suture tags will be cut. At the six-week mark, your physician will review you to ensure the bones are healing satisfactorily. At this point, it would be safe to return to your comfortable wear and gradually resume activity levels.

It takes about six to nine months for the foot to fully recover, although the bones should heal sufficiently after three months. Thus, you can resume full activity levels three months after a metatarsagia surgery.