THE WEIL OSTEOTOMY IN THE TREATMENT OF METATARSALGIA. DOES IT WORK?

Abstract

Introduction Surgical treatment of metatarsalgia remains controversial, with many different techniques described. Recently the Weil osteotomy is gaining in popularity because of its relatively simple technique and excellent union rates, however, it is well known that the procedure does lead to stiffness in the metatarsophalangeal (MTP) joint with a reduction in plantarflexion. The aim of this study was to evaluate the outcome of the Weil osteotomy from a radiological and patient-based perspective.

Method This was a retrospective review of 42 patients (110 Weil osteotomies), with mean follow up of 24.8 months (range 6–48). Clinical examination and X-ray assessment were performed at follow-up, along with completion of patient questionnaires, American Orthopaedic Foot and Ankle Society (AOFAS) Score and Lesser Metatarsal Scores (LMTS). Additional parameters including arc of motion of each metatarsal, metatarsal shortening, non-union, redislocation and requirement for further surgery were also recorded.

Results Results showed that the average arc of motion for the second metatarsal was 61.1 degrees, the third metatarsal 59.6 degrees, and the fourth metatarsal 69.8 degrees. In all cases there was a significant reduction in plantarflexion at the MTP joint, with the average combined plantar flexion of less than 5 degrees. The average shortening was 7.2 mm, and there were no cases of redislocation or non-union. Analysis of the scoring systems showed that with AOFAS there were 88% excellent/ good results and with LMTS there were 83% excellent/ good results. No patients had residual metatarsalgia and plantar callosities disappeared in almost all patients, with 91% of patients reporting excellent/good satisfaction.

Conclusion Formal scoring systems and patient satisfaction scores showed that dorsiflexion contractures post-operatively were not of concern to the patients. The study suggests that the Weil osteotomy remains a safe, reliable and predictable operation with excellent results, and may be of value in the treatment of resistant metatarsalgia.