Lesser Metatarsal Shortening Osteotomy

What are the lesser metatarsals?

Each foot has five metatarsals. These are the long bones of the foot. They connect the toes to the rest of the foot. They also make the “ball” of the foot. The lesser metatarsals are the bones that connect to the second through fifth toes. 
 

What is an osteotomy?

An osteotomy is a cut made in the bone by the surgeon.
 

What are the goals of a lesser metatarsal shortening osteotomy?

The goal of a metatarsal shortening osteotomy is to shorten the lesser metatarsal. This can accomplish two things. The first is that it lets the surgeon place a toe dislocated at the big toe joint back into position. The second is that shortening the metatarsal will lessen the pressure under it.
 

What signs indicate surgery may be needed?

Metatarsal shortening osteotomies are needed to correct toe angulation or dislocation. This is most commonly seen in


X-ray showing partially dislocated second and third toes. The toes are not completely in line with the joint and the metatarsal bones. 

hammertoe or claw toe deformities. Other less involved options may be more appropriate depending on the deformity and symptoms of the patient. However, when the toe is dislocated, the deformity must be addressed with a metatarsal shortening osteotomy. The second indication is to relieve pressure under a metatarsal head. Often this is associated with a callus and pain in the ball of the foot.
 

When should I avoid surgery?

The main reason to avoid this surgery is arthritis at the big toe joint. The shortening osteotomy would correct the toe’s position, but the patient would likely have pain due to the arthritis.

Another contraindication is chronic dislocation with severe deformity of the toe. The soft tissues, nerves and arteries contract and prevent correction of the deformity. This can lead to the nerves and arteries not working after the toe is corrected, which can result in chronic pain or gangrene of the toe.
 

General Details of Procedure

The surgeon uses a saw to cut the metatarsal bone and perform the osteotomy. The two bone ends are shifted so that the bone becomes shortened. This shortening gives “slack” to the toe and allows the toe to be placed in the correct position. Other soft tissue procedures may be required as well.
 

Specific Technique

A 1- to 2-inch incision is made over the top of the foot. The joint connecting the metatarsal with the toe is exposed. Although there are many types of metatarsal shortening osteotomies, the distal oblique metatarsal osteotomy is the most popular. A bone cut is made using a saw at the end of the metatarsal above the head. The cut is made completely through the bone. The metatarsal head can freely slide back.  After the appropriate amount of sliding has occurred, the osteotomy is held in that position with either pins or screws. The surgeon may place a temporary wire through the toe itself. The skin is then closed with stitches. 
 

What happens after surgery?

Immediately after surgery, a padded soft dressing is placed around the foot. The patient is given a hard-soled shoe and
Looking at the second and third metatarsals, these bones have been shortened by the osteotomy and are fixed by small screws and pins. Unrelated procedures were performed on the fourth and fifth toes.
  allowed to place weight only on the heel. The patient usually can go home the same day. 

Instructions are given to keep the dressing clean. Showers/bathing can be done with either a plastic bag or commercially available cover to keep the dressings dry. The patient should keep the foot elevated as much as possible to avoid swelling. Excess swelling can lead to problems with wound healing.  

The patient is usually seen in the office one to two weeks after surgery. The dressing is changed and the stitches are removed. Range-of-motion exercises with the toe may be started. If a K-Wire was placed in the toe, it is removed in the office approximately four weeks after surgery. At four to six weeks, weight bearing is usually allowed as tolerated.
 

Potential Complications

It is important to note that all the potential complications discussed are rare. The majority of patients who have metatarsal shortening osteotomies have good results.

As with any surgery, there are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

There are also complications specific to metatarsal osteotomies. Nonunion of the osteotomy is failure of the bone to heal after it has been cut. This may result in continued pain. This complication typically requires another surgery to get the bone to heal in order to alleviate the pain. 
 

Frequently Asked Questions

Will I have normal function of my toes after this surgery?
You should expect some degree of stiffness of the operative toes after this procedure. The amount of motion regained depends on the severity of the deformity before surgery and any other procedures done. Range-of-motion exercises after surgery can help to decrease stiffness.
 
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