Metatarsalgia surgery is performed under regional or general anesthesia. The specific technique depends on the cause of pain:

 

Common Surgical Techniques:

1. Weil Osteotomy (Metatarsal Shortening)

   • For metatarsal overload or long metatarsal bones.

   • A small cut is made in the affected metatarsal bone, and it is shifted back to redistribute pressure.

2. Plantar Condylectomy (Bone Spur Removal)

   • For prominent metatarsal heads causing pain.

   • Small portions of bone are removed to relieve pressure points.

3. Plantar Plate Repair

   • If metatarsalgia is due to plantar plate ligament damage.

   • The ligament is repaired to stabilize the toe joint.

4. Tendon Release or Transfer

   • For associated toe deformities (e.g., hammer toe).

   • Tight tendons pulling the toe out of position are released or repositioned.

5. Metatarsal Head Resection

   • For severe cases where joint preservation is not possible.

   • The painful metatarsal head is partially or completely removed.

 

Metal pins, screws, or sutures may be used to hold the correction in place during healing.

Before considering surgery, non-surgical treatments may help manage symptoms:

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• Footwear Modifications – Wide, cushioned shoes with a stiff sole reduce forefoot pressure.

• Custom Orthotics (Insoles) – Metatarsal pads or custom insoles help redistribute weight.

• Activity Modification – Avoiding high-impact activities reduces stress on the metatarsals.

• Pain Management – NSAIDs, steroid injections (temporary relief).

• Callus Management – Regular podiatry care if calluses develop due to excess pressure.

 

Surgery is considered when non-surgical measures fail and metatarsalgia significantly impacts daily function.

Metatarsalgia surgery has a high success rate, but some risks exist:

 

General Surgical Risks:

• Infection (<1–3% risk) – Treated with antibiotics if needed.

• Blood Clots (DVT/PE) – Rare but possible with prolonged immobility.

• Nerve Injury – Temporary or permanent numbness around the incision site.

 

Procedure-Specific Risks:

• Persistent Pain or Swelling – Some patients continue to experience discomfort post-surgery.

• Floating Toe – The toe may not touch the ground properly, affecting balance.

• Stiffness or Scar Sensitivity – The surgical site may remain tender.

• Nonunion or Malunion – If a bone is cut (osteotomy), it may not heal correctly.

• Fracture – The metatarsal bone may weaken or crack during surgery.

• Recurrence of Symptoms – If underlying biomechanical issues are not fully corrected, pain may return.

• Metal Prominence – If screws or pins are used, they may become prominent and require later removal.

 

Most patients experience significant pain relief and improved function, but full recovery may take several months.

Time Off Work

• Desk jobs: 2–4 weeks

• Manual labor: 6–8 weeks

 

Return to Driving

• 4–6 weeks, depending on swelling and pain.

 

Return to Activities & Sports

• Walking unaided: 4–6 weeks

• Running or high-impact activities: 10–12 weeks

 

Rehabilitation Timeline

• Weeks 0–2:

  • Weight-bearing depends on the procedure (protected walking in a post-op shoe).

  • Foot elevation to reduce swelling.

• Weeks 2–6:

  • Gradual return to normal footwear (soft, wide shoes first).

  • Gentle foot and toe exercises.

• 6+ weeks:

  • Resume daily activities and sports as tolerated.

  • Minor swelling may persist for several months.

 

With proper healing, most patients achieve significant pain relief and improved foot function.