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What To Know About Metatarsalgia Surgery

Surgery is a last resort for those with metatarsalgia, and it’s often also only recommended if you know what the underlying cause of the metatarsalgia is.

If your doctor believes that your metatarsalgia won’t improve with less severe treatment measures, then they may recommend surgery. But it’s advisable to try every other measure before you choose surgery.

Here’s what to know about metatarsalgia surgery.

What Are the Causes and Symptoms of Metatarsalgia?

Causes

Metatarsalgia develops over time and can be caused by a variety of different things.

The most common reason for metatarsalgia is overuse, which often results from high-impact activities like running, jumping, or other high-impact sports.

Wearing shoes that don’t offer the right support for your feet or that don’t fit properly can also lead to metatarsalgia.

Women who wear high-heel shoes that place pressure on the metatarsal heads and don’t give the toes space to splay are also prone to developing metatarsalgia.

Shoes that don’t provide enough cushioning can lead to the joints in the ball of the foot becoming inflamed and painful. It can also be caused by the fat pad in the ball of the foot diminishing as you age, which then can’t protect the metatarsal bones.

Abnormal foot structure and foot deformities can also cause metatarsalgia. Those who are overweight or obese are also at a higher risk of developing metatarsalgia, as excess pressure is placed on the forefoot.

Symptoms

You may experience a sharp pain in the forefoot, a burning sensation, or aching in the ball of your foot. It most commonly occurs in the second metatarsal joint, but it can also affect the third and fourth joints.

The pain may be accompanied by numbness or tingling, as well as redness and swelling underneath the foot. You may also feel like there’s a small pebble in your shoe when you walk or stand.

It may also increase when you step on the foot or place any pressure on the forefoot. When you rest your feet, the pain is likely to improve.

When Would You Need Metatarsal Surgery?

Surgery is a last resort for those who suffer from metatarsalgia. In most cases, surgery is only recommended in serious cases that have progressed to a fracture in the metatarsal.

Fractures in the metatarsals can be caused by an acute injury, or it could be a stress fracture that develops over time due to repetitive pressure and force on the forefoot.

The fracture may be an open fracture, where the skin has been broken, which increases the chance of infection. Or it could be a closed fracture, where the skin is intact but the bones have been displaced.

In the case of small stress fractures when the bone is just slightly cracked, there may be no need for surgery. The doctor may suggest wearing a boot for a few weeks to prevent the fracture from getting worse, as it heals.

Displaced metatarsal fractures require medical attention, as they can lead to complications. Depending on the severity of the fracture, there’s a chance that blood vessels and nerves can be trapped between broken bones, causing pain or motor problems.

Although there are other types of treatment for metatarsalgia, surgery is highly recommended for displaced fractures to ensure that the bones are properly realigned so the foot can heal correctly.

What Are the Other Reasons to Get Metatarsal Surgery?

If you don’t have a fracture, then metatarsal surgery may be recommended if the pain is debilitating and affecting your everyday life.

Your doctor may also suggest surgery if your forefoot or toes are becoming deformed.

What Are the Different Types of the Surgery

Traditional Metatarsalgia Correction

If the metatarsals are badly fractured or deformed, the traditional metatarsalgia correction can be performed. It involves cutting and repositioning the affected metatarsal bone and holding it in place with a screw or a pin—osteosynthesis.

Surgery involves an incision in the soft tissues of the foot to realign the affected bone and secure it in that position. The incision is closed with sutures once the metatarsal bone is aligned.

Minimally-Invasive Metatarsalgia Correction

This is similar to the traditional metatarsalgia surgery, but it involves a smaller incision—about 5 mm—which does very little damage to the soft tissues of the foot. It can be done when the fracture is less severe.

The surgeon then cuts and realigns the metatarsal bone through this small incision, using fluoroscopic imaging and fine, small instruments which rotate at high speeds, making precise but very small cuts in the affected bone.

This type of surgery usually requires no stitching afterward. There is also no need for a pin to hold the bone together. Doctors will most often prescribe a cast or postoperative footwear to stabilize the toe and prevent it from becoming misaligned again.

What Are the Steps After the Surgery?

You will be in a cast or post-surgery protective boot for several weeks after your surgery.

You may be required to use crutches, in order to keep any pressure off of the healing foot. Also, you will need to keep the foot dry to prevent the chance of infection.

If you had surgery in which a pin was placed into the foot, you will need to return after three to four weeks to have it removed.

You should rest your foot for six to eight weeks at a minimum before you begin to do weight-bearing activities again. When you do begin to bear weight on the foot again, you should introduce activity slowly and make sure your foot can handle it.

Once you can walk slowly with no pain, you can practice walking slightly faster. Then, you can move to light jogging. If you still have no pain, you can begin to run.

High-impact sports should be undertaken with caution, and you should definitely reassess your footwear and make sure your shoes provide adequate forefoot cushioning to protect your metatarsals.

What Happens if Recommendations Are Not Followed?

It’s extremely important to follow your doctor’s instructions closely after metatarsal surgery. Failing to do so could lead to the surgery failing, which will place you in a worse and more painful position than before the surgery.

You will need to rest the foot, as walking on it before the bones are healed can cause the bones to move out of place. They may then heal in the wrong position, which could cause more pain and inflammation in the foot. This is the most common reason metatarsal surgery is not successful.

If you walk on the foot and the bone moves downwards and heals in that position, you may develop a callus on the ball of the foot, at the metatarsal joint.

If the bone becomes elevated or lifts towards the top of the foot, you may find that a callus forms underneath the foot on a metatarsal bone next to the one which had the surgery.

You will also find that the pain remains and the joint may become inflamed and irritated, just as it was before being operated on.

What Are the Other Treatment Options?

You should try the following home treatment options if you suffer from metatarsalgia.

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Johns Hopkins. “Fluoroscopy Procedure.” Johns Hopkins Medicine, 2019,
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“Osteosynthesis – an Overview | ScienceDirect Topics.” Www.sciencedirect.com,
www.sciencedirect.com/topics/nursing-and-health-professions/osteosynthesis
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Sarpong, Nana O., et al. “Metatarsal Fractures.” Foot & Ankle Orthopaedics, vol. 3, no. 3, July 2018,
https://journals.sagepub.com/doi/full/10.1177/2473011418775094
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