The surgery consists of cutting the metatarsal bone just behind the toe. Generally, the bone is cut all the way through, and then manually elevated and held in its corrected position with a metal pin or screw. Following the surgery, the patient may be placed in a cast, or may be required to use crutches for several weeks. If a pin is used to hold the bone in place, it is generally removed in three to four weeks. Removal of the pin can be done in the doctor’s office without the need for anesthesia. While the pin is in place, the patient should keep the foot dry to prevent infection. Generally it takes a total of six to eight weeks, or longer, for the bone to heal. During this healing period, the foot should be protected from excessive weight bearing. Walking prematurely on the foot can cause the bone to shift and heal in an incorrect position. This is the most common cause of failure with this surgery. Some studies indicate a failure rate as great as 60%. If the bone shifts downward, or is not elevated enough at the time of surgery, the painful callous may return. If the bone is elevated too much, a painful callous may form under the metatarsal next to the one which was operated on.
Some surgeons will also cut out the painful callous on the bottom of the foot when they perform the metatarsal surgery. Rarely will a foot surgeon remove the painful callous without also performing the metatarsal surgery. Without correcting the metatarsal alignment, the painful callous is almost certain to return.
Most surgeons prefer to do the surgery in an outpatient surgery center or hospital. In this setting, intra-venous sedation or general anesthesia can be used for the patient’s comfort.
At the conclusion of the surgery, the surgeon places a gauze bandage on the foot. Generally, the bandage stays in place until the patient’s first follow up visit with the doctor. The skin stitches are removed in ten to fourteen days. If there are stitches in the bottom of the foot, they may remain in place for three weeks. The foot should be kept dry while the stitches and/or pin are in place to help prevent infection. May surgeons will have the patients wear a below the knee cast and/or use crutches for six to eight weeks. Other surgeons will allow the patient to wear a stiff-sole post-operative shoe, and allow limited walking on the foot.
The time required to be off work will vary with the demands of the person’s job. A minimum of one week off work would be advisable with the patient staying at home with the foot elevated above the heart.
Complications associated with this surgery are: infection, failure of the bone to heal in its correct position resulting in the return of the painful callous or transfer of the callous to a new location, delays or failure of bone healing, stress fractures of adjacent metatarsals, or excessive swelling. A common occurrence following the surgery is elevation of the toe associated with the elevated metatarsal bone that was operated on.