CPT® Code 28114

Ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal (eg, Clayton type procedure)

The procedure described by CPT® Code 28114 involves a surgical intervention known as ostectomy, specifically the complete excision of all metatarsal heads, excluding the first metatarsal. This procedure is typically indicated for patients experiencing bony overgrowth at the second, third, fourth, and fifth metatarsal heads, which can lead to pain and functional impairment. The surgical approach includes making longitudinal or lazy-S incisions over the dorsal aspects of the affected metatarsal heads, allowing for adequate access to the underlying structures. During the operation, care is taken to dissect the soft tissues while protecting the superficial blood vessels to minimize complications. The long extensor tendons are identified, and tenectomies may be performed as necessary to facilitate the excision of the metatarsal heads. The joint capsules are incised, and capsular flaps are created to expose the metatarsal heads fully. Following the excision, the bases of the proximal phalanges are also removed, and stabilization of the joints is achieved using Kirschner wires. Finally, any excess joint capsule tissue is either excised or plicated, and the overlying soft tissues are meticulously closed in layers to promote optimal healing.