Lateral Approach to the Fifth Metatarsal Head for BunionetteThe lateral approach to the fifth metatarsal head is used almost exclusively for chevron osteotomies of that bone in the treatment of bunionettes. The approach can also be used for any other procedure on the fifth metatarsal head, including the treatment of localized infection.
Although the approach is made through nonweight-bearing skin, the skin over a bunionette is frequently red, inflamed, and thin. On those rare occurrences in which frank ulceration and/or infection have occurred, nonoperative treatment of the skin must be carried out before surgery. As with all surgical approaches to the distal part of the foot, a careful vascular assessment should be done preoperatively, particularly in at-risk cases such as diabetes mellitus.
Position of the Patient
Place the patient supine on the operating table. Fix a support to the opposite iliac crest. Place a sandbag underneath the buttock on the affected side to internally rotate the leg, bringing the lateral border of the foot into the operative field. Next, tilt the table away from you to further increase the internal rotation.
After exsanguination, place a tourniquet on the middle of the thigh. Alternatively, use a soft rubber bandage to exsanguinate the foot, then wrap the leg tightly just above the ankle (see Fig. 7-1).
Landmarks and Incisions
Palpate the head of the fifth metatarsal bone and the fifth metatarsophalangeal joint along the ball of the foot and along its lateral border. In cases of bunionette, the metatarsal head is prominent laterally.
The extensor digitorum longus tendon to the little toe is easily palpable on the dorsum of the foot. When it is tight, it stands out upon passive flexion of the little toe in a plantar direction.
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