CPT® Code 28309

Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; multiple (eg, Swanson type cavus foot procedure)

An osteotomy of the metatarsal bones involves surgical procedures aimed at correcting angular deformities of the foot, specifically targeting the first metatarsal. This procedure can be performed with or without additional techniques such as lengthening, shortening, or angular correction. The primary goal of the osteotomy is to address acquired or congenital deformities, which may include conditions like hallux valgus (a bunion), metatarsus primus varus (a condition where the first metatarsal is angled inward), hallux varus (the opposite of hallux valgus), or dorsal bunion (a bunion on the top of the foot). During the procedure, the first metatarsal is carefully exposed, and the surgical approach may involve incising the metatarsophalangeal (MTP) joint capsule and dividing tendons as necessary to facilitate access to the bone. Depending on the specific deformity being corrected, the osteotomy may require excision that extends over adjacent structures such as the proximal phalanx and/or medial cuneiform bones. The technique employed can vary; for instance, a closing wedge osteotomy involves cutting the metatarsal and removing a wedge of bone to realign the structure, while an opening wedge osteotomy uses a laminar spreader to create space for alignment, often accompanied by the placement of a bone graft. This procedure is particularly relevant in cases where multiple metatarsals require correction, such as in a Swanson type cavus foot procedure, which is designed to restore proper foot function and alleviate pain associated with these deformities.