Metatarsal osteotomy

A foot osteotomy is surgery to remove parts of a bone in your foot. The bone is reshaped to relieve pressure from deformity or injury. Some examples include a fracture, bunion, hammer toe, or flat foot.

Metatarsal osteotomies can be divided into proximal and distal. The proximal osteotomies, such as the oblique, segmental, set cut, and Barouk-Rippstein-Toullec (BRT) osteotomy, all provide the ability to significantly change the position of the metatarsal head without violating the joint. These osteotomies, however, have a high rate of nonunion when done without internal fixation and can lead to transfer metatarsalgia when done without regard to the parabola of metatarsal head position. Distal osteotomies such as the Weil and Helal offer superior healing but have an increased incidence of recurrent metatarsalgia, joint stiffness, and floating toe.

Proximal and distal metatarsal osteotomies used in the treatment of hallux rigidus are suggested to provide pain relief through correction of excessive first-metatarsal length or elevation or through altering the position of the articular surface of the proximal phalanx on the first metatarsal, allowing greater movement. A large number of different procedures and techniques for metatarsal osteotomies exist, making comparison of surgical outcomes difficult.

Lesser metatarsal, or weil, osteotomy is carried out to treat toe deformities of the metatarsals (the long bones in the foot that connect the ankle to the bones) or metatarsalgia which is a type of rheumatoid arthritis; it’s often performed in conjunction with bunion surgery.

Typically, a small wedge of bone is also removed from the first metatarsal (first metatarsal osteotomy) in order to realign the joint. The bone is held in its new position with screws, pins, or plates.

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.

Metatarsal shortening osteotomies are needed to correct toe angulation or dislocation. This is most commonly seen in hammertoe or claw toe deformities. Other less involved options may be more appropriate depending on the deformity and symptoms of the patient. However, when the toe is dislocated, the deformity must be addressed with a metatarsal shortening osteotomy. The second indication is to relieve pressure under a metatarsal head. Often this is associated with a callus and pain in the ball of the foot.

You should notice a significant improvement in pain once the toe has healed (around six weeks after surgery). Most people are able to return to a good level of activity within three months, with full recovery and normal activities by six to 12 months.

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.

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Editorial Team
Journal of  Biochemistry and Biotechnology