CPT® Code 28111

The procedure described by CPT® Code 28111 refers to the complete excision of the first metatarsal head, which is a surgical intervention aimed at addressing bony overgrowth in this area. The metatarsal head is the rounded end of the first metatarsal bone, located at the base of the big toe. This condition often results in pain and discomfort, necessitating surgical intervention to alleviate symptoms and restore function. During the procedure, a longitudinal or lazy-S incision is made on the dorsal aspect of the affected metatarsal head, allowing access to the underlying structures. Careful dissection of the soft tissues is performed to protect the superficial blood vessels, ensuring minimal disruption to the surrounding anatomy. The long extensor tendons, which are responsible for extending the toes, are identified, detached, and may be transferred as needed to maintain proper function post-surgery. The joint capsule is then incised, and a capsular flap is created to expose the metatarsal head fully. The excision of the metatarsal head is performed while preserving the phalangeal base, which is crucial for maintaining joint stability. To stabilize the joint after excision, a Kirschner wire is advanced through the proximal phalanx and into the metatarsal medullary canal. Any excess tissue in the joint capsule is either excised or plicated to ensure proper closure. Finally, the overlying soft tissues are meticulously closed in layers to promote optimal healing. This procedure is specifically indicated for cases where conservative treatments have failed, and the bony overgrowth significantly impacts the patient's quality of life.