Second Metatarsal Shortening Osteotomy

What is the second metatarsal?

The metatarsals are the long bones in the foot that connect the toes to the midfoot. The metatarsals are numbered
In this pre-surgery X-ray, the red arrow points to the longer second metatarsal.
one through five, starting with the big toe. So the second metatarsal is the long bone of the second toe.

What is a second metatarsal shortening osteotomy?

This is a procedure that cuts and shortens the second metatarsal.

What is the goal of a second metatarsal shortening osteotomy?

The goal of shortening the metatarsal is to decrease pain at the base of the second toe and/or help straighten out the second toe. 

What signs indicate surgery might be necessary?

Many patients with problems have pain in the ball of their foot. Typically, they feel like they are walking on a pebble or marble. They often note more discomfort when barefoot. Many patients develop a callus (thickened skin) under the metatarsal head. Some patients have a longer-than-normal second metatarsal.
The first treatment typically is a shoe insert with pads to decrease the pressure on the painful area. A stretching program aimed at decreasing the pressure in the front part of the foot can also be helpful. Surgery may be an option if these initial treatments do not help. Also, pain due to a long second metatarsal rarely occurs by itself. This procedure typically is performed in combination with other procedures aimed at straightening the foot and decreasing the pressure on the front part of the foot.

When should I avoid surgery?

If you have not tried conservative treatment (shoe inserts, stretching), you should do so before jumping to surgery. You should avoid surgery if you have an infection in the foot or other medical problems that make the risks of surgery too dangerous for you.

General Details of Procedure

This surgery is usually done as an outpatient procedure. This means that the patient arrives one to two hours before the scheduled surgery time and goes home the same day. The procedure involves cutting the second metatarsal and removing a small section of the bone. Screws (and sometimes a plate) are used to hold the metatarsal in the shortened position until it heals.

Specific Techniques

The patient receives numbing medication for the foot along with sedation given through an IV. The orthopaedic foot and ankle
Image_Cheney_2nd_shortening_post-op.jpgIn this post-surgery X-ray, you can see the shortened second metatarsal, plus the plate and screws used for the procedure. The other screws were used for a separate fusion.
surgeon makes an incision on top of the foot in line with the second toe. The bone is visualized and a saw is used to make a cut in the bone. The bone is shortened to the desired length. It is typically held in place with one or two screws. Sometimes a plate with screws is used. The surgeon closes the incision with sutures and/or staples and places a dressing. The surgeon may also place a splint to protect the foot. Sometimes a boot or hard-soled shoe is used.

What happens after surgery?

Your orthopaedic foot and ankle surgeon will determine if you are allowed to walk or put any weight on your foot. For some patients, weightbearing is allowed the same day, but for others it may not be allowed for six to eight weeks. The goal is to transition back to supportive shoes at six to eight weeks based on bone healing. 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. The overall goal is to be 75 percent recovered at three months, 90 percent recovered at six months, and 99 percent recovered one year after surgery. 

Potential Complications

There are complications that relate to surgery in general. These include risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Complications with this procedure can include stiffness and numbness near the incision. A second surgery may be necessary if there is a delay in bone healing or a deep infection occurs.

Frequently Asked Questions

Why do I need to be non-weightbearing?
Patients should remain non-weightbearing to prevent motion between the bones that are trying to heal together. This means they should not put any weight on the affected foot. If there is too much motion between the bones it can take longer for them to heal or they may not heal at all. Bones typically take six to eight weeks to heal, so being non-weightbearing during this time should allow the bones to heal together.
What if my bones do not heal together?
The term for this is nonunion. This complication is more common in patients who have diabetes or smoke.  A nonunion, which can be seen on X-rays, may cause continued pain after surgery. A nonunion requires a second procedure called a revision surgery. New metal is typically placed during the second surgery and usually some form of bone graft is used to help the bones heal. 
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.