FA12: THE WEIL OSTEOTOMY: INDICATIONS, SURGICAL TECHNIQUE AND FIXATION

Abstract

Introduction: Lesser toe problems and metatarsalgia are common complaints in patients presenting with foot problems. Associated toe deformities include mallet toes, hammer toes, claw toes. The patient may complain of pain over the proximal interphalangeal joint from shoe ware, diffuse or localized pain under the metatarsal heads, or swelling and irritation of the metatarsophalangeal joint. Most patients can be treated with shoe ware modification, NSAID medication, tapping of toes, orthotics, or steroid injections. Surgical treatment includes flexor to extensor transfers, PIP excision arthroplasty, plantar condylectomy and metatarsal osteotomy.

Indications and Complications: The osteotomy is performed when there instability of the MTP joint, reduction of MTP joint subluxation or dislocation, relatively long ray with transfer metatarsalgia. Complications include avascular necrosis, joint stiffness, transfer metatarsalgia to subsequent toes, and plantar flexion of the metatarsal.

Surgical Technique: The Weil osteotomy is performed through a dorsal incision, performing a dorsal capsulotomy of the MTP joint and plantar flexing the proximal phalanx to expose the metatarsal head. The osteotomy is started in dorsal aspect of the metatarsal head and is made along the shaft keeping parallel to the floor. Key points are to make a long osteotomy cut to allow broad surface area for healing, avoid lowering the head by performing the cut parallel to the floor. The head will naturally displace proximally, most authors recommending 5–10mm of shortening.

Fixation: The osteotomy is fixed using a twist off screw. Factors that influence fixation include angle of screw insertion, size of the screw and the number of screws. Fixation in relatively porotic bone is improved when using two screws.