Podiatric Surgery
Lesser Metatarsal Osteotomies (Toe Joint Surgery) Introduction
This leaflet will explain what will happen when you come to the hospital for an operation to repair prominent foot joints. Why do I need this surgery? Your consultant has determined that the pain under your foot is due to one or more prominent joints. This could be because the metatarsal (big toe) bone is relatively long, or because it has “dropped� down. The proposed surgery is aimed at either elevating or shortening the bone. One or more of these bones needs to be shortened or elevated in order to restore normal weight bearing under the ball of your foot. There are a variety of surgical procedures used to shorten or elevate the bones affected. The ones used by your surgeon have a good record for correcting the problem with a low incidence of complications.
What does surgery involve? On the day of surgery you will be admitted to the ward and one of the nursing staff will check you in, take your blood pressure and perform any other tests that may be required. The surgeon will remind you of the surgical process and possible complications and ask you to sign a consent form. The surgery is performed under local anaesthetic which is administered by a series of injections around the ankle. You can have a light meal before the operation. At some point during the morning/afternoon you will be escorted to theatre. You may bring a personal stereo, book or iPod with you.
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The operation will take about 40 minutes or longer, depending on the number of procedures that need to be done. The operation involves one or more incisions on the top of your foot to gain access to the relevant bones. Your surgeon will lengthen the tendon, cut the bones and wire or screw the bone into a corrected position. The wound will be closed using non-dissolvable stitches. After surgery your foot will be bandaged and you will be supplied with a post-operative boot. You do not usually need to have your foot in a plaster cast and will not need crutches. After the operation you will be taken back to the ward and given a drink and something to eat. You will be advised on pain relief and once ready, you will be discharged from the day surgery unit. You should not drive after foot surgery and should be accompanied home by a responsible adult. You will be advised of your follow-up appointment date, either on the day or by letter in the post.
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Lesser Metatarsal Osteotomies (Toe Joint Surgery) How will I feel afterwards? Although long-acting local anaesthetic administered during the procedure should control most of the pain for about eight to 10 hours, you can expect some pain or discomfort after the operation. Painkillers will be discussed with you prior to your operation and you should bring these with you on the day of surgery.
Recovering from surgery The first two days Restrict your activity to going to the toilet only. You will be able to stand and take weight on your heel. Bend your knee and ankle regularly to stimulate circulation. Most people are able to stop taking their painkillers after 48 hours. Do not leave the house, drive or get the foot wet. Two to seven days You should aim to be moving around for a total of 10 minutes within each hour (but not in one go) as required, resting with your foot elevated for the remaining 50 minutes. Do not leave the house, drive or get the foot wet. At seven days Your foot will be examined in the outpatient clinic and your dressing will be changed. You may be advised to increase your activity, but you should still stay in your house, do not drive and keep your foot dry. Aim now to move around the house for 20 minutes within each hour. Keep wearing your post-operative boot. At 14 days At the second post-operative appointment you will probably have the stitches taken out. You will be advised to gradually increase your activity and gently exercise. You may wash and bathe normally and apply moisturising cream to the wound. You will be shown how to reapply a supportive bandage, which you should do daily. This can be removed at night. You should apply ice compresses to reduce swelling and should continue with this regime for two weeks. At four weeks Continue applying ice compresses to your foot several times each day to reduce swelling. You may now stop wearing the post-operative boot and change to wearing wide, comfortable shoes such as trainers. If you drive, you may do so when you can walk without too much discomfort. If you don’t think you are fit to drive at this stage, don’t! At eight weeks You should be walking more normally now although you may still have some mild discomfort and swelling. You will be seen for a check up and X-ray in the outpatient clinic.
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Continue regular ice packs to reduce any remaining swelling. Gradually you will recover strength, flexibility and mobility in your foot and should be experiencing the full benefit of podiatric surgery.
What are the possible risks and complications? The outcome of surgery can never be guaranteed. Every operation carries potential risks. An audit of surgery within this unit has shown good results. General complications of foot surgery Pain: There will be post-operative pain. For most people the pain passes after 24-48 hours and is tolerable with regular painkillers (following dosage recommendations). Swelling: This is a normal outcome of any operation. The extent of post-operative swelling varies and cannot be predicted. In some people the swelling reduces within a matter of weeks and in others could take many months. Application of an ice pack greatly reduces swelling. 2 PSI-2406-1713-11
Lesser Metatarsal Osteotomies (Toe Joint Surgery) Infection: There is a small risk of infection with all surgery. If this occurs it will be treated with relevant antibiotics. Look out for redness and discharge from the wound. Deep vein thrombosis (DVT): Also known as venous thromboembolism (VTE), this is a rare complication of foot surgery under local anaesthetic. The risk increases if you are having a general anaesthetic. There is also an increased risk if you smoke, take the contraceptive pill or HRT. Immobilising the leg in a cast also increases the risk of a DVT. If you have had a DVT in the past, please tell your surgeon. If you do have certain risk factors, you will have an injection to thin your blood on the day of surgery. This might need to be repeated for up to seven days following surgery. Complex regional pain syndrome (CRPS): This is a rare but difficult complication. This is an abnormal response of the nervous system to surgery but can happen after simple trauma. This can lead to a variety of painful sensations in the foot, which require medical and pain relieving techniques. Scarring: As a result of your surgery you will have a scar on your foot. To begin with the scar will be raised, red and sensitive but with time it will usually settle. Specific complications of lesser metatarsal osteomy You may lose some sensation around the operation site. Sometimes, the scar line is sore and more noticeable than normal. This will normally improve with time. The joint can lose flexibility and movement. This normally improves with time. The deformity can reoccur. Normally the pins or screws used to hold your bones in the corrected position can be left in place. However, in about 5% percent of people, they cause some irritation and need to be removed. This is a much smaller operation. Once the bone has healed, the screws/wires are no longer required. The surgery often leads to shortening of the affected toe. In some cases, the toe might become elevated and appear unsightly. This is not usually painful. Sometimes the bones fail to fuse together. This rarely occurs and might require immobilisation in a cast or further surgery. Correction of one metatarsal joint can lead to transfer of load to the next joint. This can lead to pain under the adjacent metatarsal in the ball of the foot. This is an important complication of any lesser metatarsal surgery. The surgical procedure used aims to minimise this, but should this occur, further surgery might be required.
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This leaflet is intended as a guide only. Your own post-operative recovery may vary.
Useful numbers
Braintree Community Hospital Podiatric Day Surgery Unit
01376 555 900
01376 555 908
If you have any concerns during the first 24 hours following your discharge from hospital, please telephone the ward you were on. After 24 hours, please seek advice from your GP. This document can be made available in other languages and formats upon request. Podiatric Surgery at Braintree Community Hospital, April 2015. Review due: July 2019
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