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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.
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
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.
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.
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).
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.
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.
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.
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.
The Weil osteotomy - a seven yr follow up
Linear Mode
