This procedure is well suited for older sedentary individuals, and for patients with osteopenia or osteomyelitis of the metatarsal head, where a transpositional osteotomy is not appropriate. Although transfer lesions (callus or ulcer) have been reported to occur beneath adjacent
Fig. 8.15 The Weil lesser metatarsal shortening osteotomy, (a) The lesser toe is plantarflexed, and the oblique osteotomy cut begins at the distal dorsal edge of the articular cartilage, (b) Proximal displacement of the metatarsal head, approximately 3-5 mm. Note that the head of the metatarsal is now proximal to the plantar callus. Fixation is with a single 2.0 mm screw, (c) Resection and smoothing of the bone peak.
Fig. 8.16 Technique for 5th metatarsal head resection. Before and after removal of the metatarsal head. Note that the osteotomy is angled in an oblique manner at the surgical neck of the metatarsal.
metatarsal heads, following metatarsal head resections, this is not a frequent problem with 5th metatarsal head resections.
Fifth metatarsal head resection is performed under local anaesthesia with IV sedation. An ankle tourniquet is used for haemostasis. A 4-cm dorsal longitudinal incision is made over the 5th metatarsophalangeal joint and shaft, just lateral to the extensor digitorum longus tendon. The incision is carried down to fascia, the skin edges are retracted, and the incision is then continued through joint capsule and deep to the periosteum. The joint is visualized, collateral ligaments are cut with a Beaver mini-blade, and the metatarsal is cut in an oblique manner, at the surgical neck, from distal-medial to proximal-lateral. The metatarsal head is removed, and the wound is irrigated. Gelfoam® is placed in the void, and the capsule is closed with 3-0 absorbable sutures in a simple interrupted fashion. The skin is closed with 4-0 nylon sutures, in a simple interrupted and horizontal mattress fashion. Drains are generally not necessary.
Dressings consist of non-adherent fine mesh gauze (petrolatum, 3% Xeroform™ or Adaptic™), and a fluffy dry sterile compression gauze bandage. A surgical shoe is dispensed. The patient is instructed to rest at home, remain non-weightbearing and to elevate his feet for 48 h. He is then allowed partial weightbearing in a surgical shoe with crutches or a walker. The first postoperative dressing change is scheduled within 1 week. Dressings are changed weekly for 3-4 weeks postoperatively. Sutures are removed in 14-21 days, and the patient is allowed to return to a roomy shoe with a broad toe box in 3-4 weeks.
• Can be performed under local anaesthesia with minimal risk
• Simple procedure
• Can be used for osteomyelitis
• Can be closed primarily
• Rapid return to weightbearing
• Limited disability, and rapid recovery.
• Possibility of a transfer lesion (callus or ulcer).
• Postoperative infection
• Delayed healing
• Regrowth of the transected metatarsal with recurrence of the lesion.
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