THE EARLY RESULTS OF A MODIFIED WEIL’S OSTEOTOMY OF THE FIRST METATARSAL FOR HALLUX RIGIDUS

Abstract

Introduction: A long first metatarsal is a recognized contributing factor to the development of hallux rigidus. It is possible to identify a sub-group of patients with a long first metatarsal and early hallux rigidus. L.S. Barouk & P. Barouk have recently described the use of a modified Weil shortening osteotomy for the treatment of this sub-group of patients. The purpose of the study was to evaluate the early results of a modified Weil’s osteotomy of the first metatarsal in selected patients with hallux rigidus.

Materials and Methods: Fifteen patients with mild to moderate OA of the first MTP joint in whom the first metatarsal was at least as long as the second underwent a shortening and plantar-displacing Weil’s osteotomy.

Results: At a minimum follow-up of six months all patients’ symptoms improved dramatically and the range of motion was improved in all cases. One patient, a 19 year old professional footballer, developed a stress fracture of the second metatarsal which went on to heal and he was able to return to professional football. One patient developed transfer metatarsalgia. There were no cases of AVN and all patients were satisfied with the outcome of surgery.

Discussion: There are many treatment strategies for hallux rigidus. Fusion surgery provides excellent pain relief but joint preserving surgery is preferable. Cheilectomy is reliable but has a significant failure rate. Joint replacements remain experimental. Debridement of the joint in combination with longitudinal decompression of the first MTPJ provides greater range of motion than cheilectomy alone in the subgroup of patients who have a long first metatarsal.

Conclusions: These early results suggest that in selected individuals with hallux rigidus associated with a long first metatarsal, a modified Weil’s osteotomy can improve the range of motion of the first MTP joint and result in significant pain relief.