The foot is an incredibly complex structure and whilst sometimes age or our genetics causes our feet to change over time, sometimes feet are just shaped in such a way that they don’t function as they should (i.e without causing pain).
Metatarsal surgery is ultimately quite major since you will have to stay off weight-baring activities for at least two weeks but more likely for six weeks (or more!) depending on your occupation and therefore it will only be recommended where conservative treatments have not worked, will not work or are just not available.
The main reasons you would be having this type of surgery is because you are suffering with metatarsal pain (metatarsalgia) or because you are suffering with painful foot or toe callus and corns or deformed toes. The other alternative is you have what’s known as a tailor’s bunion (aka a bunionette) which is where the little metatarsal drifts outwards and a bump forms - which causes rubbing on your shoes and unwanted pressure.
Causes of metatarsalgia
Metatarsalgia can be caused by a number of things but the main culprits are when one or more of the bones (which funnily enough are called metatarsals) are either too long or have dropped below the level of the neighbouring metatarsals. So if they’re too long it means that when you’re walking and you’re pushing up off the ground (known as toeing-off) you put more stress on it than you do the adjacent metatarsals which ends up causing pain or if it has dropped then again it can cause that particular bone to take more weight than its adjacent bones when you are standing.
If you compare the foot on the right to the foot on the left you can see that there is a lot of extra pressure on the tip of one of the metatarsals, which would be causing this individual pain.
The image on the left is the aspect, if you were looking straight down a foot (from the toe end). This is what a dropped metatarsal would look like. You can see that the 3rd bone is sticking down lower than the others, and so its not hard to imagine it takes more of the body's weight than the others.
What does the procedure involve?
There are three main types of lesser metatarsal osteotomy which each have a specific function:
- Elevatory osteotomy, where the metatarsal is lifted up to remove pressure under the joint
- Decompression osteotomy, where the metatarsal is shortened
- Rotatory (Schweil’s), or transpositional osteotomy, where the bone is rotated so as to alleviate the symptoms and improve the appearance of a baby bunion on the outside of the foot, or the bone is shifted inwards for the same effect
These types of osteotomy are each illustrated in the graphic below.