The metatarsals are the long bones behind each toe, so there are five metatarsal bones in each foot. The metatarsal bone behind the big toe is called the first metatarsal. The metatarsal bone behind the little toe is called the fifth metatarsal.
The most common metatarsal surgery is performed on the first metatarsal for the correction of bunion deformity. Surgery on the remaining metatarsal bones is performed infrequently. When surgery is performed on the second, third, or fourth metatarsal bones, it is generally for the treatment of painful calluses on the bottom of the foot or for the treatment of non-healing ulcerations on the ball of the foot.
The surgery itself consists of cutting the metatarsal bone just behind the toe. 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. Following the surgery, the patient may be placed in a cast, or may be required to use crutches for several weeks. If a pin is used to hold the bone in place, it is generally removed in three to four weeks. Removal of the pin can be done in the doctor's office without the need for anesthesia. While the pin is in place, the patient should keep the foot dry to prevent infection. Generally it takes a total of six to eight weeks, or longer, for the bone to heal. During this healing period, the foot should be protected from excessive weight bearing. Walking prematurely on the foot can cause the bone to shift and heal in an incorrect position. This is the most common cause of failure with this surgery. Some studies indicate a failure rate as great as 60%. If the bone shifts downward, or is not elevated enough at the time of surgery, the painful callus may return. If the bone is elevated too much, a painful callus may form under the metatarsal next to the one which was operated on.
Possible complications associated with this surgery are: infection, failure of the bone to heal in its correct position resulting in the return of the painful callous or transfer of the callus to a new location, delays or failure of bone healing, stress fractures of adjacent metatarsals, or excessive swelling. A common occurrence following the surgery is elevation of the toe associated with the elevated metatarsal bone that was operated on.