Question
Dr. Katz,

I have previously posted questions to you, but have yet to resolve my 2nd metatarsal pain.  (My previous post was 2/19/08) Since I憊e last posted I抳e had numerous consultations and it is thought that my first metatarsal was shortened too much during my bunionectomy and now have 2nd metatarsal overload.  One doctor tried treating me for pre-dislocation syndrome by having me wear a Darco splint (plantar flexes 2nd toe and stabilizes it.)This did not provide much, if any relief. I抳e also had 2 new pairs of orthotics neither of which did any good. I抳e put in a year of conservative treatment to no avail.  So now I am scheduled for and 2nd metatarsal Weil osteotomy and what I think he said was a capsule release?  Do you think this is a wise choice?  I抦 VERY concerned about getting a transfer lesion as my 3rd met is lower to the ground than my 2nd all ready and it is relatively the same length. I'm now even experiencing more pain in other places of my forefoot. It's hard to localize where it is.  What is your experience with this surgery?  I抦 so scared to have it done for fear of making matters worse than they all ready are. I really want to avoid surgery if at all possible, but this has been going on for so long I don抰 know what else to do?  Thanks again---Jessica


Answer
Hi Jessica,

It is common to have shortening of the first metatarsal leading to a transfer lesion.  Having a second metatarsal osteotomy can relieve the problem.  If the surgeon avoids excessive shortening, there should be no transfer to the third metatarsal.  With that being said there is still that risk regardless of the type of surgery.  This is a tough choice and there is no correct answer.  I know you've seen several drs however, you may want to get other opinions regarding the osteotomy.  You may also consider an MRI to see if you have a nerve problem and to better localize the problem.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
www.cryosurgerypodiatrist.com


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