Place the patient supine on the operating table. After exsanguination, use a tourniquet placed on the mid-thigh. Alternatively, use a soft rubber bandage to exsanguinate the foot, then wrap the leg tightly just above the ankle (see Fig. 1-1).

Palpate the shafts of the second to fifth metatarsal bones on the dorsal aspect of the foot. In cases of trauma where usually there is considerable swelling, identification of the metatarsal shafts by palpation may be difficult. In such cases, the use of radiologic control via an image intensifier will ensure that the incision is accurately localized over the area of pathology.

Make a longitudinal incision centered over the site of the pathology (Fig. 44-1). The length of the incision will be determined by the procedure. If surgery is contemplated on two adjacent metatarsal bones, center the incision between the bones to be treated. It is possible to treat two adjacent metatarsal bones through a single incision. Note, however, that this requires more retraction than would be needed for a single metatarsal bone. To reduce the risk of flap necrosis, increase the length of the incision. If all five metatarsal bones are to be treated, make two longitudinal incisions: one over the second to third interspace and the second over the fourth to fifth interspace.