This operation is performed for clawing of the toe or for metatarsalgia (pain under the ball of the foot). It involves an osteotomy (cut) of the metatarsal and a division of the tight extensor tendons. This is performed through an incision of the dorsum (back) of the foot, approximately 4cm long.
The surgery is routine, though the recovery takes quite some time.
The osteotomy requires protection in the post operative shoe for 4-6 weeks.
Risks of surgery
Stiffness & swelling
Initially the foot will be very swollen and needs elevating. The swelling will disperse over the following weeks & months but may still be apparent at 6 months. The toe will be stiff but will normally regain its original movement.
There is always a risk of infection with surgery. You will be given 1 dose of intravenous antibiotics during surgery. The best way to reduce your chances of acquiring an infection is to keep the foot elevated for 10 days. If there is an infection, it normally resolves with a course of oral antibiotics.
A nerve supplying the side of the toe, lies beneath the incision. This is at risk of damage. Usually it is just bruised and will recover. If the damage is permanent, it will leave a small patch of numbness. This does not normally cause any disability.
It is impossible to return the toe to normal and usually it remains a little lifted. This is more common in severe cases. Rarely, this is problematic and requires further surgery.
Incomplete relief of symptoms
Normally, the vast majority of symptoms will be cured by this procedure and any remaining symptoms can be accommodated by an insole.
Recovery from surgery
Elevation of the foot (above the pelvis) for the first 10 days is vitally important to prevent infection. Naturally, small periods of walking and standing are necessary.
This type of operation and the post operative shoe allow weight bearing (walking) immediately. Often this may be too uncomfortable for the first week. Crutches are usually necessary for the first for 4-6 weeks.
The surgery is routine, but the recovery is prolonged and swelling is the last feature to recover. Often footwear will still be tight at the 6-week stage and it will be 3-4 months before walking is comfortable.
Activity and time off work
In general, 2 weeks off work is required for sedentary posts, 6 weeks for standing or walking posts.
- 2 weeks for removal of sutures
- 6 weeks in Mr Rosenfeld's clinic - weight bearing X-ray
- 3 months for final review