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The Weil osteotomy - a seven yr follow up

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  #1  
Old 31st October 2005, 04:35 PM
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Default The Weil osteotomy - a seven yr follow up

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The Weil osteotomy - A SEVEN-YEAR FOLLOW-UP
From JBJS
Quote:
We prospectively evaluated the one- and seven-year results of the Weil osteotomy for the treatment of metatarsalgia with subluxed or dislocated metatarsophalangeal joints in 25 feet of 24 patients. Good to excellent results were achieved in 21 feet (84%) after one year and in 22 (88%) after seven years. The American Orthopaedic Foot and Ankle Society score significantly improved from 48 (SD 15) points before surgery to 75 (SD 24) at one year, and 83 (SD 18) at seven years. The procedure significantly reduced pain, diminished isolated plantar callus formation and increased the patient’s capacity for walking. Redislocation of the metatarsophalangeal joint was seen in two feet (8%) after one year and in three (12%) after seven years. Although floating toes and restricted movement of the metatarsophalangeal joint may occur, the Weil osteotomy is safe and effective.
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  #2  
Old 2nd November 2010, 02:26 AM
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Default Re: The Weil osteotomy - a seven yr follow up

The translating Weil osteotomy in the treatment of an overriding second toe: A report of 25 cases
Bernhard Devos Bevernage, Paul-André Deleu and Thibaut Leemrijse
Foot and Ankle Surgery
Volume 16, Issue 4, December 2010, Pages 153-158

Quote:
We present a retrospective study of 25 feet operated for an overriding second toe deformity, whether or not associated with hallux valgus deformity and metatarsalgia. The surgical technique of a medial sliding and decompressive Weil osteotomy is described. All patients, operated between January 2002 and December 2007 for this condition in our institution, were reviewed clinically and radiologically. The mean AOFAS score improved with 47.6 points from 45.9 to 93.5. The theoretical advantages of such a translation Weil osteotomy are discussed trying to clarify the previously described pathologic anatomy of this condition
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Old 23rd June 2011, 09:24 AM
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Default Re: The Weil osteotomy - a seven yr follow up

Complications of the Weil Osteotomy
Peter Highlander, Eric VonHerbulis, Aldo Gonzalez, Joshua Britt, Jacqueline Buchman
Foot Ankle Spec June 2011 vol. 4 no. 3 165-170
Quote:
Introduction. The Weil osteotomy is commonly used for multiple forefoot pathologies yielding metatarsalgia. Despite its common use, the Weil osteotomy is associated with a high complication rate.

Methods. A literature review was undertaken with predetermined criteria. To maximize the articles for review, prospective and retrospective studies were considered as well as multiple indications. Seventeen articles qualified for analysis, and study format, patient demographics, surgical indication, and complication rates were documented. The data obtained were totaled and evaluated for trends.

Results. Details of 1131 Weil osteotomies are reported. The most commonly reported complication of the Weil osteotomy was floating toe, reported in 233 cases, with an overall occurrence of 36%. Recurrence was reported in 15% of the cases. Transfer metatarsalgia was reported in 7% of the cases, whereas delayed union, non-union, and malunion were collectively reported in 3% of the cases.

Discussion. There is no consensus regarding utilization of the Weil osteotomy with prophylactic surgery, plantar plate repair, and adjunctive interphalangeal arthrodesis. These variables may alter complication rates and provide new avenues for research.
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Old 22nd July 2011, 03:54 AM
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Default Re: The Weil osteotomy - a seven yr follow up

Weil osteotomy: Assessment of medium term results and predictive factors in recurrent metatarsalgia
A. Khurana, S. Kadamabande, S. James, H. Tanaka and K. Hariharan
Foot and Ankle Surgery; Volume 17, Issue 3, September 2011, Pages 150-157
Quote:
Background
The angle of the Weil osteotomy is usually referenced relative to the floor irrespective of the plantar angulation of the metatarsal. This study aims to analyse the long term results following the Weil osteotomy and identify the cause of poor outcome.

Methods
This study presents a retrospective review of 61 patients (86 feet), with mean follow-up of 31 months. Each patient underwent clinical, pedobarographic and radiological examination. The radiographs obtained included ‘Metatarsal Skyline Views’ (MSV), to assess the plantar declination of the metatarsal heads following the osteotomy. The functional scoring was performed using AOFAS and Foot Function Index.

Results
Fifty-five patients (80 feet) showed good to excellent results clinically. Six patients had persistent metatarsalgia. All these 6 patients had callosities beneath metatarsal heads. Pedobarography showed peak pressures in the same distribution as callosities and the MSV showed increased plantar declination of the metatarsal heads. This correlation was found to be significant (p < 0.05).

Conclusion
The Weil osteotomy is a safe and effective treatment for metatarsalgia. An MSV radiograph is helpful to identify the plantar prominence of metatarsal which can be associated with poor clinical outcomes.
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Old 22nd July 2011, 03:58 AM
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Default Re: The Weil osteotomy - a seven yr follow up

Comparative study of the Weil osteotomy with and without fixation
D. García-Fernández et al
Foot and Ankle Surgery; Volume 17, Issue 3, September 2011, Pages 103-107
Quote:
Background
Weil osteotomy is a technique widely used in patients with metatarsalgia which shortens the metatarsal and reduces the load under the metatarsal head.

Methods
The aim of this paper is to compare the results of the Weil osteotomy with and without any fixation system.

We present a retrospective study of 92 patients (97 feet) who underwent treatment for metatarsalgia between 1999 and 2005. One hundred and six osteotomies were vixed using a screw amd no fixation was used in 92. The mean follow-up was 51.2 and 46.6 months respectively.

Results
All the patients were evaluated following the AOFAS LMIS scale, obtaining a mean score of 69.8 points (ranged 15–100) and 75.3 points (from 47 to 100) in each group (P = 0.11).

Conclusions
The results of fixed and unfixed Weil osteotomies were not significantly different. Our study could not find a significant relationship between metatarsal shortening and main complications (recurrent metatarsalgia, transfer metatarsalgia and stiffness of the metatarsophalangeal joint).
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Old 30th August 2011, 12:48 PM
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Default Re: The Weil osteotomy - a seven yr follow up

Distal osteotomy of the lateral metatarsals: A series of 72 cases comparing the Weil osteotomy and the DMMO percutaneous osteotomy.
Henry J, Besse JL, Fessy
Orthop Traumatol Surg Res. 2011 Aug 26.
Quote:
INTRODUCTION:
A Weil osteotomy with internal fixation can match the preoperative plan by precisely setting the metatarsal length; however 10 to 30% of patients end up experiencing postoperative stiffness. A percutaneous distal metatarsal mini-invasive osteotomy (DMMO) is a purely extra-articular technique; metatarsal length is set automatically upon weight bearing of the foot. The goal of this study was to compare these two osteotomy techniques when performed on the three or four most lateral metatarsals.

HYPOTHESIS:
A DMMO will result in better joint motion than a Weil osteotomy.

PATIENTS AND METHODS:
This was a retrospective, single center, single surgeon study with 72 patients. Group 1 consisted of 39 patients operated by the DMMO technique. Group 2 consisted of 33 patients operated by the standard Weil osteotomy technique. In some cases, a procedure on the first ray (Scarf or fusion) was also performed. The age, gender and procedures on the first ray were comparable for both groups. Patients were evaluated with clinical (AOFAS score) and radiological outcomes (Maestro criteria) at 3 and 12 months minimum follow-up.

RESULTS:
Sixty-seven patients were seen again with an average follow-up of 14.8 months (range 12-24). The postoperative AOFAS score was comparable in both groups (86.5 and 85.3, respectively). The joint range of motion was comparable in both groups. Static problems (oedema, metatarsalgia, hyperkeratosis and dislocation) were comparable at the last follow-up. The metatarsalgia recurred in four patients from group 1 and five patients from group 2. After 3 months, oedema and metatarsalgia were significantly greater in group 1. Radiological measurements (M1P1angle, M1M2angle and Maestro criteria) were comparable. Metatarsal head recoil was identical between each ray in group 1. At the last follow-up, all the osteotomy sites had achieved union.

DISCUSSION AND CONCLUSION:
The results of static metatarsalgia treatment were comparable when using a DMMO or Weil osteotomy. However the DMMO had longer postoperative recovery, notably because of oedema. The percutaneous DMMO technique did not improve joint range of motion.
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  #7  
Old 1st September 2011, 12:52 AM
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Default Re: The Weil osteotomy - a seven yr follow up

I'd be interested to know more about the post-op care and advice. Also, it would be interesting to have an overview of the average daily physical demands these patients experience and whether they were using orthoses etc.
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  #8  
Old 7th November 2011, 12:09 PM
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Default Re: The Weil osteotomy - a seven yr follow up

Complications of the Weil osteotomy.
Highlander P, VonHerbulis E, Gonzalez A, Britt J, Buchman J.
Foot Ankle Spec. 2011 Jun;4(3):165-70
Quote:
Introduction. The Weil osteotomy is commonly used for multiple forefoot pathologies yielding metatarsalgia. Despite its common use, the Weil osteotomy is associated with a high complication rate.

Methods. A literature review was undertaken with predetermined criteria. To maximize the articles for review, prospective and retrospective studies were considered as well as multiple indications. Seventeen articles qualified for analysis, and study format, patient demographics, surgical indication, and complication rates were documented. The data obtained were totaled and evaluated for trends.

Results. Details of 1131 Weil osteotomies are reported. The most commonly reported complication of the Weil osteotomy was floating toe, reported in 233 cases, with an overall occurrence of 36%. Recurrence was reported in 15% of the cases. Transfer metatarsalgia was reported in 7% of the cases, whereas delayed union, non-union, and malunion were collectively reported in 3% of the cases.

Discussion. There is no consensus regarding utilization of the Weil osteotomy with prophylactic surgery, plantar plate repair, and adjunctive interphalangeal arthrodesis. These variables may alter complication rates and provide new avenues for research.
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  #9  
Old 1st June 2012, 09:09 PM
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Default Re: The Weil osteotomy - a seven yr follow up

The Role of Weil and Triple Weil Osteotomies in the Treatment of Propulsive Metatarsalgia Israel Perez-Mu˜noz, MD; David Escobar-Anton, MD; Tomas Angel San
Foot & Ankle International June 2012 (Vol. 33 #6) June 1, 2012
Quote:
The Weil and triple Weil osteotomy are widely used to treat third
rocker metatarsalgia. The aim of this study was to analyze the results
and complications of Weil and triple Weil osteotomy used for the
treatment of third rocker metatarsalgia.

Methods: This is a report of
82 patients who were operated due to third rocker metatarsalgia from
March 2004 to May 2007. A total of 76 completed the study, 68 women
and eight men, with a total of 93 operated feet, 52 right and 41 left (
17 bilateral). The clinical results were evaluated using the AOFAS
score for the assessment of lesser metatarsals and interphalangeal
joints, and weightbearing lateral and AP foot X-ray for radiological
evaluation.

Results: The median AOFAS score was 90 (range, 34 to 100).
We had good results in 80% and unsatisfactory in 20%. Prior to surgery
75 feet were index minus, but after all 81 feet were plus-minus. With
regard to complications, we had serious recurrence of metatarsalgia in
4.3%, moderate stiffness in 60.2% (severe in one case), floating toes
in 4.3% and delays in bone healing in 7.5%.

Conclusion: We believe that
Weil and triple Weil osteotomies are effective procedures in the
treatment of third rocker metatarsalgia. We feel preoperative planning
with tracing on the weightbearing AP radiographs is an essential step.
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Old 18th September 2012, 07:03 PM
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Default Re: The Weil osteotomy - a seven yr follow up

From Podiatry Today:
Are You Taking The Easy Way Out With The Weil Osteotomy?
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  #11  
Old 18th September 2012, 07:08 PM
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Default Re: The Weil osteotomy - a seven yr follow up

Related Threads:
Other threads tagged with weil osteotomy
JP Driver-Jowitt is an orthopaedic surgeon lambasts the Weil osteotomy
Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability
Is the Weil Osteotomy Overused?
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Old 21st November 2013, 06:50 PM
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Default Re: The Weil osteotomy - a seven yr follow up

Second metatarsal osteotomies for metatarsalgia: A robotic cadaveric study of the effect of osteotomy plane and metatarsal shortening on plantar pressure
Darrin J. Trask et al
Journal of Orthopaedic Research; Early View
Quote:
Symptom relief of recalcitrant metatarsalgia can be achieved through surgical shortening of the affected metatarsal, thus decreasing plantar pressure. Theoretically an oblique metatarsal osteotomy can be oriented distal to proximal (DP) or proximal to distal (PD). We characterized the relationship between the amount of second metatarsal shortening, osteotomy plane, and plantar pressure. We hypothesized that the PD osteotomy is more effective in reducing metatarsal peak pressure and pressure time integral. We performed eight DP and eight PD second metatarsal osteotomies on eight pairs of cadaveric feet. A custom designed robotic gait simulator (RGS) generated dynamic in vitro simulations of gait. Second metatarsals were incrementally shortened, with three trials for each length. We calculated regression lines for peak pressure and pressure time integral vs. metatarsal shortening. Shortening the second metatarsal using either osteotomy significantly affected the metatarsal peak pressure and pressure time integral (first and third metatarsal increased, p < 0.01 and <0.05; second metatarsal decreased, p < 0.01). Changes in peak pressure (p = 0.0019) and pressure time integral (p = 0.0046) were more sensitive to second metatarsal shortening with the PD osteotomy than the DP osteotomy. The PD osteotomy plane reduces plantar pressure more effectively than the DP osteotomy plane.
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Old 22nd March 2014, 06:53 AM
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Default Re: The Weil osteotomy - a seven yr follow up

Modification of the Weil/Maceira Metatarsal Osteotomy for Coronal Plane Malalignment During Crossover Toe Correction: Case Series.
Klinge SA, McClure P, Fellars T, Digiovanni CW.
Foot Ankle Int. 2014 Mar 20.
Quote:
BACKGROUND:
Metatarsophalangeal joint (MPJ) instability, which often involves the second ray, may result in dorsal translation and coronal drift of the proximal phalanx, with subsequent crossover of the first and second toe. After traditionally described soft tissue and osteotomy procedures are used to treat this deformity, coronal plane malalignment may persist, but few additional surgical options have been described to address this problem.
METHODS:
We present a retrospective series of 5 patients who underwent a supplemental technique to augment coronal plane MPJ realignment. All patients underwent preplanned concomitant procedures. Crossover angulation of the second MPJ, amount of coronal translation required, and overall first-second ray alignment were compared pre- and postoperatively.
RESULTS:
Depending on the severity of refractory deformity after soft tissue release and decompressive metatarsal osteotomy, 1.5 to 4.5 mm of coronal plane metatarsal head translation was required to achieve 3 to 20 degrees of overall valgus correction at the MPJ and complete correction of the crossover toe deformity. All patients were satisfied and had good function at last follow-up, a mean of 10.2 months, although 3 patients exhibited some level of second MPJ stiffness. One patient ended up with a component of residual floating toe deformity that was considered more of an incomplete correction of dorsal MPJ subluxation rather than any technical complication of this translational osteotomy modification designed to primarily correct coronal plane malalignment. A second patient had asymptomatic angular malalignment through partial (coronal plane) malrotation of the metatarsal osteotomy before it had healed.
CONCLUSIONS:
We have found this technique modification to be a very effective and simple means of treating recalcitrant lesser MPJ coronal plane malalignment when traditional soft tissue and bony techniques fail to fully restore anatomic MPJ position.
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Old 3rd May 2014, 08:31 AM
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Default Re: The Weil osteotomy - a seven yr follow up

Effectiveness of the Dorsal Thermoplastic Locking Orthosis to Prevent Floating Toes in Postoperative Follow-up of Weil Osteotomies
Pilot Study

Alexandre Leme Godoy-Santos, MD, PhD; Tulio Diniz Fernandes, MD, PhD; Candida Luzo, OT, CHT; Rafael Trevisan Ortiz, MD; Marcos Sakaki, MD; Lowell Weil Junior, DPM, MBA, FACFAS
Foot Ankle Spec May 2, 2014 1938640014532131
Quote:
Background: The Weil oblique distal metatarsal osteotomy is regularly used in the treatment of primary metatarsalgia. The most frequent complication is the floating toe, which occurs in up to 36% of postoperative follow-up. The theory of reducing the plantar flexor mechanism tension associated with the retraction of the dorsal structures during the healing process of the surgical procedure may explain this negative evolution.

Objective: This study aimed at assessing the effectiveness of the Tucade dorsal thermoplastic locking orthosis in the prevention of floating toe after Weil osteotomy.

Methods: In all, 30 patients with metatarsalgia diagnosis submitted to Weil osteotomy were treated in the postoperative period with the Tucade dorsal thermoplastic locking orthosis.

Results: The floating toe was not observed in this case series. There was 1 case of superficial wound irritation at the dorsal surgical incision and 1 case that evolved with transfer metatarsalgia. Statistical analyses were performed—American Orthopaedic Foot and Ankle Society Scale for lateral toes and extension of the lateral toes—using the t test, and P < .0001 was obtained for comparison of the preoperative and postoperative periods in the population studied.

Conclusion: The Tucade dorsal thermoplastic locking orthosis during the postoperative period of Weil osteotomy proved to be effective in the prevention of floating toes.
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Old 24th July 2014, 06:21 PM
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Default Re: The Weil osteotomy - a seven yr follow up

Proof of Concept: Experimental Metatarsal osteotomy Leads to Greater Reduction in Plantar Pressure Versus Weil Osteotomy and its Modifications
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