Podiatry Arena members do not see these ads

Weil, Weil, Weil….!

Enquiries about the Weil Osteotomy have been frequent on this web-site. I have therefore asked on this site (and in conferences around the world) for both orthopaedic and podiatric communities to explain how the Weil works. Just what does it do to correct pain?

Despite many thousands of hits on my web-site no one has come forward with a valid explanation.

In the literature two pseudo-explanations are offered.

“Restoration of the metatarsal parabola (by shortening a metatarsal)”. Here it is reasoned that an unusually long metatarsal is responsible for pain, particularly the second. It is claimed that the “normal foot” has the metatarsals forming a neat parabolic curve. Is there any evidence for that? Not that I can find. Foot shapes come in great variety. A lifetime of looking at feet has never revealed a “better” or “correct” shape. Most feet function well for the first three-quarters of life, irrespective of significant variances. There is no hard evidence either that a “long” metatarsal is more prone to pain than a short one. What is true is that the second metatarsal often happens to be the first to become painful, and (by chance association) the second metatarsal also happens to be the longest.

Even the “benefit” of shortening is not universally agreed among the Weil exponents. The foundation design of the Weil is to angle the metatarsal in the sagittal plane. We therefor have those who explain that the length of the painful metatarsal is what needs to be corrected. Another school claims that it is the angle which need to be corrected. So which is it?

But even if that association (long metatarsal = pain) should be correct, the argument immediately fails when Weil osteotomies are offered on multiple toes, or on a toe which is painful but has a shorter metatarsal. The ultimate irrationality of this argument is that any given foot anatomy (perhaps with a long second metatarsal, or with a “non-parabolic” shape) can function perfectly well for fifty or sixty years before becoming painful.

When that foot becomes painful is it because the metatarsal is “long”? Of course it is not – that metatarsal has had the same length all those years – and has functioned perfectly during the times when the greatest loads have been on it, youthful sport, running, jumping, pregnancies, and the rest. So some would try to make us believe that after half a century of service, that bone suddenly becomes “too long”! Really!

The other pseudo-argument promoting the Weil goes like this (copied from a podiatric site): “When conservative modalities have been exhausted, you may consider over 20 surgical techniques, ranging from condylectomies to oblique osteotomies at the proximal, mid-shaft or distal metatarsal levels. Of these procedures, the Weil osteotomy has gained popularity, based upon the simple technique and stable fixation.”

This is another way of saying “If a surgeon is going to try something surgically he should try the easiest “something””.

“Try” is the operative word.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~

PLEASE ADD YOUR COMMENTS HERE:

http://orthopaediciq.org/foot-abnorm...teotomy/757-2/

__________________

DJ Fellner DPM
http://www.linkedin.com/in/dfellner

Tweet

Share

Related threads:
The Weil osteotomy - a seven yr follow up
Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability
Is the Weil Osteotomy Overused?
Other threads tagged with weil osteotomy

__________________
Are you addicted to Podiatry Arena?
Have you added your location to the map? (Map FAQ's)
Earn CPD Points

There are three types of osteotomies for lesser metatarsals. Those that shorten, those that lift, and those that are a combination.
I have used a pedograph pre and post operatively for years in both midstance and propulsion. If a metatarsal head shows excessive pressure at midstance, it makes sense that the metatarsal head has to be lifted. If the excessive pressure is at propulsion it makes sense that the bone has to be shortened.

Regards,

Stanley

Dr Beekman, always lovely to see your replies and this one has a certain parsimony in the vein of Occam's Razor. The assumptions are few and the application pragmatic, and who can argue with the positive outcomes.

Dave Smith

__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.

When that foot becomes painful is it because the metatarsal is “long”? Of course it is not – that metatarsal has had the same length all those years – and has functioned perfectly during the times when the greatest loads have been on it, youthful sport, running, jumping, pregnancies, and the rest. So some would try to make us believe that after half a century of service, that bone suddenly becomes “too long”! Really!

Plantar fat pad atrophy in combination with structural deformity likely represents an additive effect which can often times be corrected with a Weil osteotomy. As far as technical difficulty is concerned I think it would be hard to argue that a plantar condylectomy is more difficult to perform, then again what do I know I'm still just practicing.

Sorry I didn't answer this is the previous post.

When people age, the joint range of motions decrease including the metatarsal cuniform (or cuboid) joints. The normal imperfections of height and length are no longer able to be compensated for, necessitating the off loading of the metatarsal head. This off loading can be obtained either by orthoses or surgery.
This is by no means the complete story. For instance a short leg can cause 5th metatarsal pathology, especially with an equinus and weak peroneals.

Regards,
Stanley

I agree that this is by no means the complete story. I'm not aware of a longitudinal study on the quantifiable changes in gait as we age, but we all know those changes exist and alter the biomechanics of locomotion. I'm not advocating Weil osteotomies for all geriatric patients with metatarsalgia but the procedure does seem to work well with proper patient selection.