It can take up to 12 weeks to get back to regular shoes, and recovery time is largely determined by other procedures performed at the same time as the shortening osteotomy. A metatarsal osteotomy is a surgical procedure performed to treat a foot deformity. 2). Because the metatarsals lie in an almost subcutaneous position, access is relatively easy; however, care must be taken to respect the neurovascular structures on the dorsum of the foot, especially the cutaneous nerves. The bone is visualized and a saw is used to make a cut If you have a torn tendon in your foot, your foot physician will recommend a treatment option based on the severity of your tear. This surgery involves cutting the metatarsal bone of the big toe and realigning the bone to correct the deformity. The five long bones of the mid-foot are known as metatarsal bones. Physical therapy will be important for your recovery. The dorsal approach to the second to fifth metatarsal bones provides safe access for surgery in a number of conditions. have hearing loss, Surgical treatment: metatarsal osteotomy (shortening the affected metatarsals and elevating the metatarsal heads), Metatarsal head slides posteriorly and possibly inferiorly depending on cut angle, Commonly performed, but complications include floating toe deformity, transferred metatarsalgia, return to initial symptoms, dorsiflexion contracture, and increased MTPJ stiffness1,2, Not commonly performed, but avoids possibility of inferior sliding of metatarsal head. The surgery is routine, though the recovery takes quite some time. It is performed to decrease pressure on a prominent metatarsal head in the forefoot. This operation is performed for clawing of the toe or for metatarsalgia (pain under the ball of the foot). A second metatarsal shortening osteotomy is a procedure that cuts and shortens the second metatarsal. If conservative treatment does not provide relief, you may need foot surgery to relieve pressure in the tarsal tunnel. Left and right arrows move across top level links and expand / close menus in sub levels. A second metatarsal shortening osteotomy is a procedure that cuts and shortens the second metatarsal. If you need medical advice, use the ", How to Be Non-weightbearing After Surgery. 2409 North 45th Street, Seattle, WA 98103, 5350 Tallman Ave NW Ste 500, Seattle, WA 98107. Stance phase simulations were scaled to 50% body weight and 4.09s. A custom aluminum bracket stabilized the osteotomies and allowed sequential shortening to targets of 0 mm, 2mm, 4mm, and 6mm during testing (Figure2). Nonsurgical treatment options may include a short cast or special shoe. The Novel emed pressure plate is attached to the surface of the force plate. Depending on your foot deformity and the type of procedure needed, you can expect to return to activity within two to three months. A stretching The skin incision is only 3mm long over the top of the foot. Statistical analysis: linear mixed effects regression. org/ 10. American Orthopaedic Foot & Ankle Society. This has the advantage of rotating the relatively well-preserved plantar cartilage dorsally to recreate a more anatomic articulation, while also allowing some degree of shortening to offload the metatarsal head . The procedure planned is Left First MTP Cheilectomy, and 2nd & 3rd distal metatarsal osteotomy. A shorter first metatarsal bone bears less weight and pressure; With the first metatarsal bearing less weight, the 2nd metatarsal must bear additional pressure and weight; The extra pressure causes pain and inflammation of the 2nd metatarsal head. They often note more discomfort when barefoot. A metatarsal osteotomy is a surgical procedure performed to treat a foot deformity. to heal together. Most people can walk normally after the foot has healed. Treatment is based on supportive measures. The angle of the osteotomy should be as close as possible to parallel to the weight-bearing surface. San Francisco CA 94123. 33e2. second metatarsal using either osteotomy signicantly affected the metatarsal peak pressure and pressure time integral (rst and third metatarsal increased, p<0.01 and <0.05; second metatarsal decreased, p<0.01). It is performed to decrease pressure on a prominent metatarsal head in the forefoot. Table 1: Regression analysis results for second metatarsal PP and PTI. visit VeteransCrisisLine.net for more resources. Complications that are specific to the Weil Osteotomy include: Previously edited byDaniel Guss, MDandJustin Greisberg, MD), FootEducation LLC Recovery takes one to two months, depending on the type of deformity being corrected and the type of surgery used to correct it. MedStar Healths dedicated center for foot and ankle treatment is known internationally for its comprehensive care for foot pain relief that helps you return to the activities you love. Regarding the DP osteotomy, other studies have shown: This work was supported by VA RR&D grant A4843C and the University of Washington MSRTP program. The PD osteotomy achieved a greater reduction in second metatarsal PP and PTI than the DP osteotomy. Foot fractures can be diagnosed using imaging, such as X-rays. "Surgery is usually a last option," says Dr. Koivunen. Aim of . If there is too much motion between the bones it can take longer for them to heal or they may not heal at all. Statistical analysis. The bone is then fixed in its new position with screws and the cut . Figure 3: Second metatarsal PP (top) and PTI (bottom) for two representative pairs. It offers many advantages over more traditional osteotomies, including stability and a large area of bone-to-bone contact. A delay in bone healing or a deep infection may require additional surgery. Did you know our resouces can be found in. The metatarsals are the long bones in the foot that connect the toes to the midfoot. Many patients develop a callus (thickened skin) under the affected metatarsal head. A case of cross union between first and second metatarsal following Mitchell's osteotomy for hallux valgus in a 57-year-old lady is presented. Typically, they feel like they are walking on a pebble or marble. Original article by Nicholas Cheney, DOReviewers/Contributors: Jeff Feinblatt, MD. The slope of the second metatarsal PP and PTI linear regressions was greater in the PD osteotomy than the DP osteotomy (Table1). You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Secondary metatarsalgia, congenital malformation, pes cavus, Freiberg's disease, gastrocnemius retraction were excluded The surgery began with DMMOs of the 2nd and 3rd metatarsals, then a minimally invasive chevron osteotomy adjusted the length of the 1st metatarsal in relation to the lateral rays. Your foot and ankle orthopedic surgeon will determine if you are allowed to walk or put any weight on your foot. Some patients are at risk for this due to a longer-than-normal second metatarsal. Metatarsal Osteotomy and TMT Fusion. A case of Freiberg's infraction is presented that is treated with joint debridement and dorsiflexory wedge osteotomy of the second metatarsal. Introduction. Recovery can take six months to a year. The operation aims to strengthen the great toe, and narrow the forefoot. It is often at least6-12 months before a full recovery is obtained. Before proceeding with this surgery, your foot and ankle orthopedic surgeon typically will try a non-surgical treatment such as a shoe insert with pads to decrease the pressure on the painful area. Figure 1: Radiographs of DP (top) and PD (bottom) osteotomies. Stitches are often removed 10 to 14 days after surgery. A Weil metatarsal is a surgical procedure to cut (osteotomy) and shorten the metatarsal bone. (Surgery may involve a number of procedures, including hammertoe repair and/or metatarsal osteotomy / bone repositioning, and/or bunion surgery. neuroma (interdigital neuralgia) treated with metatarsal sliding osteotomy. Surgical correction. Park EH, Kim YS, Lee HJ, Koh YG (2013) Metatarsal shortening osteotomy for decompression of Morton's neuroma. Many patients with problems have pain in the ball of their foot. 2nd MTP joint)-This joint tends to be stiff as there is a tendency to form a significant scar in this area. This is a Weil osteotomy of the 3rd metatarsal with screw fixation for a plantarflexed, painful metatarsal joint of the right foot. What is a lesser metatarsal osteotomy? An additional Weil osteotomy of the second metatarsal was performed in all feet. Bones typically take 6-8 weeks to heal, so being non-weightbearing during this time should allow the bones Foot tendon reconstruction is a procedure to repair torn tendons, such as an Achilles heel tear. There are 3 main types of osteotomies used by foot and ankle surgeons; namely akin osteotomy, chevron osteotomy . Bruce J. Sangeorzan , M.D. Grant C. Roush, M.S. The lesser metatarsals are the bones behind the 2nd, 3rd, 4th and 5th toes. The goal is to transition back 217678 10. too dangerous for you. The patient receives numbing medication for the foot along with sedation given through an IV. After a calcaneal osteotomy, you can expect to return to your favorite activities within six months. 1. Steroid injections should never be performed into the fat pad under the ball of the foot, but depending on the diagnosis and thought process of your surgeon, an injection may be done through the top of your foot into the joint or tissue to the side of the joint. Dr. Niemann of Foot & Ankle Clinics of Arizona performs a Bunionectomy, Midfoot Fusion and Second Metatarsal Osteotomy on his patient at Advanced Surgical Ca. During an osteotomy the bone is cut and its position is changed in order to shift the pressures from one part of a joint to another. Most patients who have hammertoes try to manage them by. Weil Ostetomy surgery is used to relieve pain under the ball of the foot. 2 The osteotomy starts in the dorsal (2-3 mm) articular surface of the metatarsal. The Scarf Osteotomy is a Z-shaped metatarsal osteotomy, which is commonly used for the correction of an increased intermetatarsal I/II angle in patients with hallux valgus [28]; its main advantage . 4. An oblique sliding osteotomy to manage the second metatarsal is effective in patients with moderate or severe hallux valgus and improves scores on American Orthopaedic Foot and Ankle Society scores. There are several different surgical options available, depending on the cause and symptoms of a bunion. A second metatarsal shortening osteotomy is a procedure that cuts and shortens the second metatarsal. William R. Ledoux, Ph.D. Green line indicates angle of cut. The overall goal is to be 75% recovered at three months and 90-100% recovered between six and twelve months after surgery. It is similar to breaking the bone but in a very controlled manner. A long lesser metatarsal can lead to common toe problems. Complications with this specific procedure can include stiffness and numbness near the incision. The circle shows the dislocation of the second toe. Left: X-ray before surgery. If you have tarsal tunnel syndrome, your foot specialist may recommend nonsurgical treatments, such as rest, elevation, massage, anti-inflammatory medications, steroid injections, arch supports (orthotics), and/or better-fitting shoes. The metatarsals are numbered one through five, starting with the big toe. Your foot specialist will work with you to develop a treatment plan that will work best for you. Some nonsurgical treatments may provide relief, including rest, immobilization, shoe inserts, braces, and physical therapy. A stationary bike or swimming is typically safe after the sutures have been removed. and space open menus and escape closes them as well. In the majority of patients, surgery of the second metatarsal, object of the present study, was accompanied by surgery of another metatarsal during the same surgical act, following the Leventen formula and/or by proximal phalanx osteotomy and flexor tenotomy. greater than 15 degrees. I had it dine due to the metataesal bone was a little too long, and caused ball of the foot pain. During metatarsal surgery, a foot surgeon will cut the metatarsal bone of the big toe and realign the bone to correct the deformity. . The surgeon also may place a splint to protect the foot. Screws and sometimes a plate are used to hold the metatarsal This is performed through an incision of the dorsum (back) of the foot, approximately 4cm long. When anti-inflammatories and better shoe choices aren't enough to keep the pain from coming back, your doctor may recommend surgery. There are many cases where the surgeon will perform both bunionectomy and osteotomy to correct the issue. The ball of the foot is known as the metatarsophalangeal joint (MTPJ) region. to supportive shoes at 6-8 weeks based on bone healing. During bunion surgery, called a bunionectomy, foot surgeons will realign bone, ligaments, tendons, and nerves so the big toe can be brought back to its correct position. What is second metatarsal shortening osteotomy. The surgeon closes the incision and places a dressing. Mark Reed, MD In severe cases of foot arthritis, you may need surgery to reshape or replace the bones in the affected foot joint. You should avoid this surgery if you have an infection in the foot, have poor circulation in the foot, or other medical problems that make the risks of surgery Acknowledgements This work was supported by VA RR&D grant A4843C and the University of Washington MSRTP program. PP and PTI for first, second and third metatarsal heads was calculated from pressure masks created from pre-operative radiographs; three trials were obtained for each second metatarsal length. Furthermore, osteotomy surgery consists of double or single V-shaped osteotomy of the middle part of your metatarsal bones performed within the dorso-plantar type of plane that belongs to proximal metaphysic. Sometimes a boot or hard-soled The involved metatarsal bones are carefully cut, shortened and (usually) fixed in place again with small screws. 9 This original procedure is seldom used because of its technically demanding nature, involving the use of a bone graft wedge, and concerns about nonunion and instability. I'm three weeks out from plantar plate repair with 2nd toe osteotomy. Overlapping second toe - Severe deformity. If the metatarsal is relatively low in the sagittal plane, then it is elevated with an osteotomy. It involves an osteotomy (cut) of the metatarsal and a division of the tight extensor tendons. The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. P Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations). Most people can walk normally after the foot has healed. Swelling of the foot/toe is expected and can take anywhere from 6 weeks to 6 months to fully resolve. Left: X-ray before surgery. The overall goal is Your surgeon selects the appropriate surgical procedure based on the type of bunion and its severity. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area. The site navigation utilizes arrow, enter, escape, and space bar key commands. However, for long-lasting pain relief and improved walking ability, you may need surgery. Lesser metatarsal stress fractures (usually involving the 2nd or 3rd metatarsal bone) are associated with pain in the midfoot to forefoot. The PD osteotomy achieved a greater reduction in second metatarsal PP and PTI than the DP osteotomy. It involves shortening and elevating the prominent metatarsal using a minimally invasive burr. The circle shows the dislocation of the second toe.Right: X-ray after surgery showing the second toe in the correct position. A nonunion may require a second procedure. Request PDF | On Jan 1, 2009, Carol Frey published Second Metatarsal Shortening Osteotomy | Find, read and cite all the research you need on ResearchGate Your surgeon will recognize this on X-rays or CT scan and may recommend a second Removing the bone allows the surgeon to reposition the big toe. The bone is visualized and a saw is used to make a cut in the bone. This osteotomy incorporates the long oblique osteotomy described by Weil, with an additional dorsal closing wedge component that resects the diseased aspect of the metatarsal head , . Lesser metatarsal surgery primarily aims to restore the metatarsal parabola to one of the accepted . 2. A nonunion may cause continued pain after surgery. Home > Blog > Questions and Answers > What is second metatarsal shortening osteotomy? During a procedure called a second metatarsal osteotomy, a foot surgeon cuts away part of your second metatarsal to shorten it. The bone is shortened to the desired length. J Bone Joint Surg Am. For some patients, weightbearing is allowed the same day, but for others it may not be allowed for 6-8 weeks. Then, youll be able to begin walking with a boot on your foot. Sometimes a boot or hard-soled shoe is used. This surgery usually is done as an outpatient procedure, meaning the patient can go home the same day. 4103/ 0019- 5413. This means they should not put any weight on the affected foot. This began distally and dorsally approximately 1 to 2 mm below the edge of the dorsal articular margin. Surgery may be an option if these initial treatments do not help. Diagnosis Many patients with problems have pain in the ball of their foot. in the shortened position until it heals. The osteotomy was then carried proximally and plantarly at approximately a 45-degree angle. The patient had prior fo. 1177/ 10711 00713 . First metatarsal proximal opening wedge osteotomy is a proximal corrective osteotomy for hallux valgus deformity that was first described by Trethowan. Arthrodesis of the First Metatarsophalangeal Joint: a Robotic Cadaver Study of the Dorsiflexion Angle. Purpose: to compare the effects of second metatarsal shortening on plantar pressure with the DP and PD osteotomies. When a. patient presents complaining of a "bunion." the clinician must first. Patients' mean age was 57.88 6.55 years. The osteotomy requires protection in the post operative shoe for 4-6 weeks. Guyton, Miller, Wisbeck, and Hembree average 4.7 stars, as reported by 945 patients (as of July 12, 2019). A millimeter or so was removed and a permanent pin was used to hold position. Metatarsalgia describes pain in the region of the ball of the foot (metatarsal heads), this region at the base of the toes takes load when pushing off, standing on the toes or wearing shoes with a heel. To our knowledge, no study has explored reductions in plantar pressure with the PD osteotomy. Metatarsalgia surgery involves different procedures, which include metatarsal osteotomy, bunion surgery or repositioning of bones. Drs. for professional medical advice, diagnoses or treatments. A saw is then used to cut the bone parallel to the sole of the foot. In your research, we're confident that our foot and ankle doctors will rise to the top. An incision is made on top of the foot over the involved metatarsal bones (usually 2 nd and 3 rd ). Normal Bony Motion Using a Kinematic Foot Model, First Metatarsophalangeal Joint Fusion Angle. 3. To access the menus on this page please perform the following steps. An oblique shaft metatarsal osteotomy is performed to correct a wider fourth-to-fifth intermetatarsal angle or a deformity that involves bowing with a lateral curvature to the metatarsal. Reflective Vicon markers are placed on the tiba and lateral and medial malleoli. In the second surgery, new metal is typically placed and some form of bone graft is used to help the bones heal. And, our compassionate team is dedicated to research and innovation, ensuring you receive the most advanced care to improve and maintain healthy feet. This surgery usually is done as an outpatient procedure, meaning the patient can go home the same day. X-rays (radiographs) These show the degree and angles of the toe deformity, as well as any arthritis in the joint. The goals of shortening the metatarsal are to decrease pain at the base of the second toe (in the ball of the foot) and/or help straighten out the second A metatarsal osteotomy is a surgical procedure performed to treat foot deformities, such as hammertoe. Iatrogenic transfer metatarsalgia is a common complication of hallux valgus (HV) surgery , , .The causes of transfer metatarsalgia are multifactorial and may include shortened first metatarsal bone length, dorsiflexion or plantarflexion of the metatarsal, stiff first metatarsophalangeal joint, and changes in the normal weightbearing mechanics of the foot , . The management of hallux valgus is . For some patients, weightbearing is allowed the same day, but for others it may not be allowed for 6-8 weeks. Hallux & Metatarsal Osteotomies: First Metatarsal basal Osteotomy, Scarf/Chevron Osteotomy, Weil Osteotomy /BRT Osteotomy, Osteotomy of Proximal Phalanx (Akin, Moberg) Postop: Heel wedge shoes & Heel weight bearing for 6 weeks Foot elevation 7 to 10 days Follow-up: 2 weeks Wound check & ROS at plaster room Wednesday P.M. clinic shoe is used. They typically occur following prolonged or repetitive walking and are sometimes called "march fractures.". LCovi. The position of the toes was guided by a bandage for 2 weeks relayed by a molded orthoplasty for 4 weeks. If you are in crisis or having thoughts of suicide, on the affected foot. The surgery consists of cutting the metatarsal bone just behind the toe. Of special note is the bracket attached to the 2nd metatarsal used to shorten and secure the bone after the osteotomy. procedure. The procedure involves cutting the second metatarsal and removing a small section of the bone. If you have an intense tear, your doctor will use tendon tissue grafts, taken either from elsewhere in the leg or from a tissue bank, to reconstruct the torn tendon. Depending on the specific procedure performed as well as other factors, you may be told to remain non-weightbearing to prevent motion between the parts of the bone that are trying to heal together. This complication, called a nonunion, is more common in patients who have diabetes or smoke. 1. A stretching program for the Achilles and calf muscles aimed at decreasing the pressure in the front part of the foot also can be helpful. A Weil Osteotomy is performed by making an incision over the base of the second (or other involved) toe. A negative value indicates a reduction due to shortening (p < 0.01). Depending on the specific procedure performed as well as other factors, the patient may be told to remain non-weightbearing to prevent motion between the parts of the bone that are trying to heal together. Your foot and ankle specialist will recommend a treatment plan based on your unique case. Achilles Tendon Tears and Injuries Perspective from Dr. Walter Hembree. However, if nonsurgical options dont help, you may benefit from surgery. This patient had Mitchell's osteotomy on both her feet 7 years back. Location: Lake Geneva, WI. The foot and ankle orthopaedic surgeon makes an incision on top of the foot in line with the second toe. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. After the surgery, the bone that has been cut needs to heal. After surgery, you will need to stay off of your foot for at least six weeks. In one week, I've having foot surgery to address the pain in the ball of my foot/toes. org/ 10. Osteotomy. Generally, the bone is cut all the way through, and then manually elevated and held in its corrected position with a metal pin or screw. Symptoms of fractures of the second or third metatarsals include: Toe pain Swelling Tenderness Walking with a limp The presence of a callus under the toe in question Inhibited range of motion Diagnosing and Treating March Fractures Diagnosing these injuries begins with a clinical examination from a foot specialist like Dr. Silverman. Wearing roomier shoes or using protective pads to cushion your big toe may help to relieve the burning pain in your big toe. Thats why during a calcaneal osteotomy, a foot surgeon will cut the heel bone to move and secure it in a better location. An 'osteotomy' is an operation when the bone at the base of the toe (the metatarsal bone) is divided and 'displaced' into the correct position. The metatarsal head was displaced in a plantar direction as part of the scarf osteotomy to reduce the . Significant decrease in PP at toe-off and neutral stance using the DP osteotomy4, No difference in PP between an intact second metatarsal and DP osteotomy5, Fixation method may not accurately simulate post-operative metatarsal healing, Decreased gait velocity and body weight were used. An osteotomy is a cut made in the bone. It is held in place with some type of implant. Eric C. Whittaker,M.S. Veterans Crisis Line: Posts: 2. Many patients develop a callus (thickened skin) under the affected metatarsal head. Surgery for Metatarsal Injury. If there is too much motion between the bones it can take longer for them to heal or they may not heal at all. A paired t-test was used to evaluate differences between measurements taken preoperatively and at final follow-up. Attention A T users. A hammertoe is a deformity that causes a toe to become bent upward in the middle so it resembles a hammer. Once these complications have occurred, the surgeon may choose a metatarsal shortening osteotomy to decompress the MTP joint and decrease the tension on . All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. A lesser metatarsal shortening osteotomy changes the pressure distribution under the ball of the foot, relieving pain. Darren J. Trask, B.S. If you have a deformity in your foot or ankle, such as flatfoot, a calcaneal osteotomy will help to relieve pain, improve alignment and walking, and reduce the likelihood of arthritis. Dr. Mark Reed is a board-certified orthopedic surgeon providing specialty care of all foot and ankle disorders. The ligaments sometimes also need to be re-balanced. This video shows a cadaveric gait simulation of stance phase from a distance, including the entire RGS system. For less severe tears, you may just need sutures, or stitches, to repair the tear. The metatarsal head fragment is then stabilized in the new position with one or two small screws or pins. It can take up to 12 weeks to get back to regular shoes, and recovery time is largely determined by other procedures performed at the same time as the shortening osteotomy. Double chevron osteotomies with 20 of plantar-ward obliquity at the proximal metatarsal level were made at 5-mm intervals for simultaneous valgus correction and metatarsal shortening. Hit enter to expand a main menu option (Health, Benefits, etc). The Surgery. Metatarsalgia may be associated with toe deformities such as claw or hammer toes as well as a long metatarsal (usually the second). Orthopedic Specialists of Seattle provides new and advanced procedures including endoscopic carpal tunnel release surgery for carpal tunnel syndrome, complex joint restoration procedures, anterior approach hip replacement surgery, and more. Shortening the second metatarsal will decrease second metatarsal head PP and PTI and increase first and third metatarsal head PP and PTI across surgery type. Risk factors for development of a stress fracture include an increase in activity level, a foot . Hammertoes often occur in conjunction with other toe problems. During the procedure, foot surgeons will restore the arches in your feet, which will help improve the pressure on your feet as you stand and walk. Change location Fig. This allows the metatarsal head to be shifted backwards towards the heel, approximately 3 to 5 mm, though in some cases even farther. If you have a foot fracture, your foot physician will develop a treatment plan based on the severity of your injury. A Weil osteotomy is performed in the metatarsal. Treatment options may include anti-inflammatory medication, arch supports for your shoes, or physical therapy. Osteotomy literally means cutting of bone. This video shows a cadaveric gait simulation of stance phase from a dorsal view. The surgeon closes the incision and places a dressing. They often note more discomfort when barefoot. Also known as dropped metatarsal heads, metatarsalgia can cause abnormal . Procedure A Weil Osteotomy is performed by making an incision over the base of the second (or other involved) toe. Six paired feet and two unpaired feet were included in study (8PD, 6DP; two unpaired DP osteotomies were excluded due to poor surgical technique). A Weil metatarsal is a surgical procedure to cut (osteotomy) and shorten the metatarsal bone. The surgeon will also reduce or lengthen surrounding tendons and ligaments. The calcaneus, or heel bone, plays an important role in walking. Call TTY if you I'm in a walking boot - weight bearing on the heel - and sometimes it's fine . Note that the pad should not be placed under the painful area, but just toward the heel side of the painful area. Many patients with problems have pain in the ball of their foot. Dissolvable skin stitches may be used. New metal is typically placed during the second surgery and usually some form of bone graft is used to help the bones heal. Translation of the first distal metatarsal head was assessed by measuring the perpendicular distance between the second metatarsal axis and the distal metatarsal head lateral articulation (Fig. It is held in place with some type of implant. 7 The scarf osteotomy can maintain the length of the first metatarsal and allow an early mobilization after surgery. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The goals of shortening the metatarsal are to decrease pain at the base of the second toe (in the ball of the foot) and/or help straighten out the second toe. 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