Lesser metatarsal, or weil, osteotomy is carried out to treat toe deformities of the metatarsals (the long bones in the foot that connect the ankle to the bones) or metatarsalgia which is a type of rheumatoid arthritis; it’s often performed in conjunction with bunion surgery.
What does it involve?
Usually a day case procedure, surgery is carried out under a general anaesthetic with an injection in the foot to reduce pain after surgery.
The operation normally involves one incision (cut) around the area where the toe meets the foot, on the top of the foot. If more than one metatarsal is to be operated on then more than one incision may be used. The bone is then cut (known as an osteotomy) and repositioned, effectively shortening it slightly to relieve the pain under the foot and/or toe clawing. The osteotomy is held in place with a small metal screw that stays in afterwards.
Immediately after surgery:
- Your foot will be bandaged, numb and pain free
- You will be referred to a physiotherapist who will help with a personalised rehabilitation programme, and offer advice on walking in a padded stiff shoe which will be supplied
- You will be sent home only when you are comfortable and given a follow-up appointment and painkillers if required
During the first few weeks:
- Elevate your foot (above the level of your heart) as much as possible to reduce the swelling
- Move around only when you need to, for example to wash or use the toilet. Don’t put weight on the operated leg
- Some blood ooze can be expected in the bandage. If you are worried, contact the Fortius Clinic
- Take painkillers as prescribed
- Avoid smoking and taking anti-inflammatory medications as this may delay or even prevent the bones from fusing together
Everyone is different, so healing and post-operative programmes vary from person to person. However, the schedule of follow-up appointments below is typical:
- Two weeks - your bandages will be removed and you will be shown how to practise toe stretches
- Six weeks - any special boots/insoles will be removed and you will be given an X-ray
- 12 weeks - final appointment and discharge
When can I start to walk?
Your surgeon will be able to advise you about the type of footwear you should use and how quickly you will recover. Below is a guide to what may be advised:
- 0-6 weeks - you will be able to fully weight bear in a hospital shoe
- After six weeks - you will be able to fully weight bear in your own shoes
How do I wash and shower?
During the first two weeks it’s important to keep the bandaging/foot totally dry although you will be able to shower with a waterproof cover over the foot. After two weeks you can shower without the cover if the wound is healed, but gently dab it dry.
How can I look after the wound?
Once the bandage is removed, don’t pull at your scabs, let them fall away naturally. If your wound becomes red, swollen or sore you should contact the Fortius Clinic and arrange to see your consultant to check you don’t have an infection.
Physiotherapy and rehabilitation
Your physiotherapist will guide you through the stages of rehabilitation including gait re-education (walking correctly), toe mobilisation exercises, swelling reduction and reducing muscle tightness. You may also be given advice on massaging your wound once it has healed.
When can I start to drive again?
The DVLA states it’s the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot during an emergency stop and this will usually take at least six weeks. Although your specialist will advise you about when it’s safe to start driving again, it remains your responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.
When can I return to work?
This depends on the type of work you do and how quickly you recover. As a general guide, if your job involves sitting down for most of the time, you should be able to return to work after two weeks; if it involves manual work, you may need to have up to eight weeks off.
What long-term outcome can I expect after surgery?
You should notice a significant improvement in pain once the toe has healed (around six weeks after surgery). Most people are able to return to a good level of activity within three months, with full recovery and normal activities by six to 12 months. However, you may still have some mild swelling and stiffness in the toe for up to a year.
What are the risks?
Below is a guide to the risks of this type of surgery. However, your surgeon will discuss these with you before your procedure, and answer any questions you may have:
Infection: The chance of infection is around 1% and can usually be treated with antibiotics. Serious problems caused by infection are very rare and can be treated
Nerve damage: Small nerves that supply feeling to the skin near the operation site can be damaged, although the risk is very small (around 5%). If your toe stays numb after surgery, the nerve may be bruised but will usually recover
Toe stiffness: The toe can remain a little stiff but this should improve if you follow your physiotherapist’s advice
Deep Vein Thrombosis (DVT): You may be given blood-thinning medication after the surgery if you are at a higher risk of DVT (where a blood clot forms in a deep vein in the leg). However, the risk of this is less than 3% and may be reduced if you keep your ankle moving and carry out the recommended exercise
Important:This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other people’s. Please contact us for advice if you’re worried about any aspect of your health or recovery