Weil’s osteotomy is claimed to correct a number of forefoot problems, including “metatarsalgia”, “claw toes”, “dislocations of the metatarso phalangeal joints”, lengthening metatarsals, shortening metatarsals and even “slimming the foot”! (Barouk). Some even claim that it can be used to correct veer. How any procedure designed to alter abnormalities in the vertical (sagittal) plane can correct malalignment in the horizontal plane defeats me.
Any single surgical procedure which claimes a benefit for such different pathologies (or pathologies of unknown cause, which is often the case in current forefoot surgery) must be regarded with the same scepticism warranted by blood-letting as a “catch all” cure.
One rationale justifying Weil’s osteotomy is that it purports to correct “Morton’s Foot”, where the second metatarsal is longer than the first. An irony here is that many types of surgery used for “bunions” shorten the first metatarsal, and so create a “Morton’s foot”.
The reality is that there is no rationale for this procedure. If it is of perceived to be beneficial, then it is purely by chance, and the procedure should then be regarded as a “noxious placebo“ [ http://drjpdriverjowitt.wordpress.com/curriculum-vitae/noxious-placebos/ ]
The following paper by podiatrists http://www.ncbi.nlm.nih.gov/pubmed/12043986?dopt=Citation claims the Weil to be a good procedure, but see below:
“The surgical management of central metatarsalgia. Foot Ankle Int. 2002 May;23(5):415-9.
O’Kane C, Kilmartin TE. Department of Podiatric Surgery, Ilkeston Hospital, Derbyshire, England. firstname.lastname@example.org
Seventeen patients (20 feet) underwent Weil osteotomies of the second and third metatarsals for the treatment of central metatarsalgia and were reviewed at an average of 18 months postoperatively. Fourteen patients were completely satisfied with the results of their surgery (85%), one patient was satisfied, one patient satisfied with reservations and one patient was dissatisfied. The American Orthopaedic Foot and Ankle Society clinical rating scale improved by an average of 44 points. One patient had complete recurrence of symptoms, eight out of the 40 toes involved in surgery were floating, four toes were stiff, there were three cases of infection, and transfer metatarsalgia affected the fourth metatarsal in one case. The Weil osteotomy is an effective and safe procedure for the treatment of central metatarsalgia.”
However, when read from the point of view of complications, this paper is not encouraging because:
15% were less than completely satisfied
20% had floating toes
10% toes were stiff
7% had infection
2% had “transfer metatarsalgia.
Of course these complications are not additive arithmetically. It is likely that those who had complications had more than one complication. It is equally likely that those complications were not all confined to the 20% who had the floating toes, and it is here that the bald statistics hide the more important information about the spread of complications. As a result we simply do not know who had which complications.
Another difficulty is that the numbers are statistically small and the follow up relatively short, considering that these feet are to be used for the remainder of life. Finally people do adapt to disabilities and often underrate their disabilities on review. (see the paper on “bunions”)
Now consider the following paper by orthopaedic surgeons:
Department of Orthopaedic, Hospital Gersthof, Vienna, Austria. email@example.com
Hardly any surgical methods are available for metatarsalgia caused by a dislocated lesser metatarsophalangeal joint (MTP) that do not sacrifice the joint. We reviewed retrospectively the outcome of 60 metatarsal Weil osteotomies for correction of dislocated lesser MTP joints in 31 patients. Between 1995 and 1996, 31 consecutive patients were treated with a Weil osteotomy at 2 institutions. The Weil osteotomy is an oblique osteotomy of the metatarsal neck and shaft, parallel to the ground surface, that controls shortening of the metatarsal by internal fixation with screws or pins. At an average final follow-up of 30 (24-44) months, all patients were interviewed, using a standardized questionnaire based on the AOFAS Lesser Metatarsophalangeal-Interphalangeal Scale. Recurrent or transfer metatarsalgia, formation of callus, mobility and dislocation of the MTP were noted on physical examination. Dorsoplantar and lateral weightbearing radiographs taken preoperatively and at the time of final follow-up were examined for alignment of the metatarsal heads, subluxation or dislocation and for evidence of nonunion, or malunion of the metatarsal osteotomy. We had excellent results in 21 patients (42 osteotomies). A major complication was plantar penetrating hardware in 10 cases (3 screws and 7 pins). We conclude that the Weil osteotomy is a good method for correcting metatarsalgia caused by dislocation of the MTP joint.”
Twenty four percent (10/42) of the procedures had what the authors call “major complications”, and the phrasing seems to imply that there were other (perhaps “minor”) complications. Hardly the kind of risks many would knowingly accept.
I would welcome correspondence from those who perform Weil’s osteotomy justifying its use.