We present the results of the first two years of experience with the Weil osteotomy at The Royal Oldham Hospital and endeavour to define its role in the management of intractable plantar keratosis (IPK) and complication rate.

All patients undergoing Weil osteotomy in 2000 & 2001 were included in this prospective study. A total of 21 consecutive patients, having 61 lesser metatarsal osteotomies were reviewed (95% female). The mean age was 62 years (range 12 to 86). The mean follow-up period was 17 months (range seven to 28 months). Fourteen patients (66%) had no previous foot surgery. In 11 patients (53%) only Weil osteotomy was performed; in the other 10 patients (47%) the procedure was combined with surgery to the first ray for the correction of hallux valgus deformity.

There were no major complications. Superficial wound infections in four (19%) patients were treated successfully with antibiotics. No screws needed to be removed and no non-union / avascular necrosis were seen. Only one patient was left with residual pain and stiffness on ambulation but the rest (95%) were able to walk comfortably in either normal shoe wear or trainers.

We found that the patients consistently reported pain relief although some stiffness of the toes may remain. The majority of patients were satisfied with the outcome in terms of symptoms and function when evaluated by using the American Orthopaedic Foot and Ankle Society scoring system. Excellent results (90–100 points) were achieved in 10 patients (47%), good (80–89 points) in six patients (28%), fair (70–79 points) in four (20%) and poor (less than 70 points) in only one patient (5%). We conclude that although there is a considerable learning curve that must be overcome the Weil osteotomy can be a reliable procedure that effectively reduce the load under the lesser metatarsal heads.