Metatarsalgia: What it is and how the surgery works
SmartHallux® Method
Smarthallux explains to you
All you need to know
on metatarsalgia
What does metatarsalgia mean?
Metatarsalgia refers to a series of conditions that have a common denominator: pain in the metatarsals, the five long, thin bones located just before the toes. The area most commonly affected by pathological processes is the head of the metatarsal, the part of the bone that articulates with the toes.
There are many pathologies that can cause metatarsalgia, but the most common are biomechanical metatarsalgia and Morton's neuroma.
Biomechanical metatarsalgia refers to an overload pathology that affects the metatarsals. Biomechanical metatarsalgia is mainly due to a pathology affecting the big toe, in particular the hallux valgus (more frequent in the female gender) and the hallux rigidus (more frequent in the male gender).
The alteration of the functionality of the big toe, associated with other factors such as overweight, repeated microtraumas following sporting or professional activities, prolonged use of safety shoes, can lead to functional overload and, therefore, pain.
Metatarsalgia: How to Recognize It
To diagnose metatarsalgia, simply assess the location of the pain and the presence of any calluses under the sole of the foot. To accurately determine the causes of metatarsalgia, a specialist examination and a weight-bearing X-ray of the foot are essential.
Often, a foot and ankle surgeon can diagnose the problem in just a few steps. The most common manifestation of overuse metatarsalgia is the formation of hyperkeratosis (common calluses).
An x-ray of both feet, performed in orthostatism (i.e. standing), is the most accurate examination for the surgeon, as it is in orthostatism that the foot performs its functions and it is in orthostatism that the patient feels pain.
Metatarsalgia: treatment
Treatment of biomechanical metatarsalgia varies depending on the underlying cause, the patient's age, and their functional needs. Conservative treatment, in the initial stages, can lead to complete or incomplete regression of the pain, particularly in cases of metatarsalgia caused by overload (related to sports or work).
A custom-made insole or insole, which allows the heads of the affected metatarsals to be unloaded, can represent a valid solution in subjects with poor functional demands, considering that the insole does not have a corrective effect.
There are no shoes that are more or less suitable for those suffering from metatarsalgia, but sometimes shoes with a "rocking" sole can help unload the forefoot in the push phase and improve the symptoms, which can last a few days or forever.
The goal of SmartHallux
SmartHallux's goal is to revolutionize the treatment of metatarsalgia and all forefoot conditions. To achieve this goal, we adopt the best surgical techniques, orthopedic devices, instruments, and materials available on the market.
This is why we propose ourselves as private healthcare at an accessible and financeable cost. Unfortunately, public and subsidized healthcare have spending limits that place limits on the use of materials, instruments and structures.
With SmartHallux you will have access to the best possible treatments, in excellent facilities and without having to wait for public health authorities.
Surgical techniques have undergone an important evolution compared to the past, starting from anesthesia and post-operative pain control.
Our surgical techniques
Metatarsalgia: the surgery
The surgical technique we use at SmartHallux is called DMMO (Distal Minimally Invasive Metatarsal Osteotomy). Essentially, cuts are made in the bone (called "osteotomies") with a motorized drill, without incisions but through three small "holes" that leave no scars.
SmartHallux uses the highest quality disposable materials to guarantee maximum sterility and drastically reduces the risk of transmitting infectious diseases and metallosis (the dispersion of metal debris into tissues, which can lead to chronic inflammation) compared to reusing burs. Disposable materials also ensure greater cutting precision and are environmentally friendly, as they do not require resterilization, thus saving water and electricity.
The surgical procedure is based on the correction of the metatarsal formula, in addition to the possible correction of pathologies affecting the big toe.
In addition to correcting functionality, metatarsal surgery can also correct the aesthetics of the foot, improving the shape and length of the toes and reducing their diameter. This results in a more pleasing foot that fits more easily into the desired shoes, even the most tapered and high-heeled ones.
Metatarsalgia: anesthesia
The anesthesia we use at SmartHallux does not involve painful ankle injections or uncomfortable spinal anesthesia or general anesthesia.
Using ultrasound guidance, our anesthesiologists are able to identify the nerves and, with a single puncture behind the knee, selectively "numb" the nerve structures necessary and sufficient to perform the procedure painlessly, leaving the patient with full mobility of the legs and bladder control. Sedation allows the patient to avoid anxiety and, often, to wake up immediately after the surgery.
This type of anesthesia also allows for the anesthesia to be prolonged for up to 24-48 hours, reducing or even eliminating post-operative pain, without any risks or contraindications.
Duration of the intervention
The operation is generally performed as day surgery: the patient enters the hospital in the morning and returns home the same evening.
Back to activities
From the day after the operation, when sensitivity is completely recovered, the patient can walk with full support on his foot, wearing a very advanced post-operative shoe specific for this type of surgery, significantly different from the post-operative shoes commonly in use.
The only restriction remains driving vehicles for 7 days.
The first check-up is performed approximately 15 days after surgery. During this check-up, the stitches are removed and a second dressing is applied. A second check-up is performed approximately 4 weeks after surgery, during which all dressings are removed and the patient can return to weight-bearing without any aids, wearing a pair of comfortable shoes.
Complete recovery generally occurs 2-3 months after surgery. Patients can return to contact sports within 3-4 months.
Complications and risks of the surgery
The risks and complications associated with metatarsalgia surgery are very rare, especially with non-invasive surgery. They include bleeding, allergic reactions, infections, deep vein thrombosis, embolisms, and skin complications, nerve damage with loss of sensation, persistent pain at the scar, delayed union, pseudoarthrosis, and joint stiffness. The use of antibiotics and low molecular weight heparin further reduces the risk of complications.
Why choose SmartHallux for surgery?
Our doctors, led by Dr. Manzi, have extensive experience in treating metatarsalgia with a very high percentage of satisfied patients.
The secrets of our success lie in the use of the best surgical and anesthesiological techniques, and the use of cutting-edge, top-quality materials.
Waiting times for metatarsalgia surgery through the National Health Service (NHS) can be very long, varying from region to region and from facility to facility. In some cases, the wait can be several months or even years. SmartHallux offers the opportunity to access surgery more quickly, avoiding long waiting lists.
Regarding costs, metatarsalgia correction surgery can vary depending on the technique used, the complexity of the case, and the healthcare facility where it is performed. Typically, the average cost is around €8-€9.000. At SmartHallux, thanks to the advanced technique used and our collaboration with several clinics, you can get a significantly more competitive price.
SmartHallux® Certified Clinics
Our offices
San Camillo Nursing Home - Via Mauro Macchi, 5, 20124 Milan MI
UPMC Salvator Mundi International Hospital V.le delle Mura Gianicolensi, 67, 00152 Rome RM
Ruesch SPA Clinic Viale Maria Cristina di Savoia, 39, 80122 Naples NA
Smarthallux Netherland - Statenplein 21 - 2582 EZ Den Haag
SmartHallux United Kingdom - Cromwell Hospital 164-178 Cromwell Rd, London SW5 0TU, United Kingdom
Smarthallux Madrid - Calle de Hermosilla 95 - 28006 – Madrid Spain
FAQ
There are several options for booking a consultation with Dr. Manzi.
Dr. Manzi visits medical practices that collaborate with SmartHallux located in Rome, Milan and Naples
It is also possible to book a telemedicine visit.