Short-term outcome of Weil osteotomy in treatment of metatarsalgia]

INTRODUCTION: The aim of this retrospective study was to analyse the short term results after the Weil-procedure for the treatment for metatarsalgia in 30 consecutive patients. METHODS: 30 patients (69 osteotomies) after the Weil-procedure with an average age of 60 years (range 25 to 78 years) were analysed by clinical and radiological evaluation. The average follow up was 15 months (range 12 to 26 months). Analysis was performed using the patients' records, weight-bearing radiographs and a standardized questionnaire. RESULTS: Subjective evaluation revealed 23 very satisfied and satisfied patients. Based on the Lesser-Metatarsal-Interphalangeal-Scale the objective results showed 77.1 points on average. The results were excellent in 17 cases, good in 4, fair in 3 and unsatisfactory in 6 cases respectively. Recurrent metatarsalgia was noted in 5 cases, whereas no transfermetatarsalgia was observed. The average shortening was 4.4 mm. Subluxation of the metatarsophalangeal joint was corrected in 18 out of 22 cases. A restricted plantar flexion of the metatarsophalangeal joint was noted in 14 cases. 2 patients showed loss of movement. CONCLUSION: Our short-term results reveal that the Weil-osteotomy is a sufficient treatment for metatarsalgia. This technique is able to reestablish the alignment of the metatarsals and to correct luxation and subluxation of the metatarsophalangeal joint. Restricted plantarflexion of the metatarsophalangeal joint is a drawback, which may be avoided by intensive physiotherapy.     

Weil截骨术与Jacopy截骨术治疗应力性跖痛症的临床疗效对比观察

背景：跖痛症是指发生于跖骨头下方的前足疼痛,可由解剖结构异常、病理性或医源性因素诱发。其病变主要是因为前足集中的局部应力负荷反复作用造成。治疗可分为保守治疗与手术治疗,对大部分跖痛症而言,采用保守治疗即可取得较好的疗效,若保守治疗无效,则可采取手术治疗,其目的是恢复前足正常的应力分布。目的：探讨跖骨远端weil截骨术与Jacoby截骨术治疗应力性跖痛症的临床疗效,从而为临床上更加合理有效的治疗跖痛症提供方法和依据。方法：2010年5月至2012年9月,我院收治应力性跖痛症患者65例,其中42例（63足）患者资料完整,得到随访,男8例（13足）,女34例（50足）;年龄39～78岁,平均56-3岁。单侧11例,双侧31例;病变于第2跖骨头下24例,第3跖骨头下ll例,第2、3跖骨头下同时累及7例。合并跖趾关节脱位12例,跽外翻畸形16例,跖间神经瘤5例。所有病例随机分为A、B两组,A组19例（32足）,B组23例（31足）。A组采用跖骨远端Weil截骨术、B组采用Jacoby截骨术治疗,经过平均18个月的随访,对手术前后局部疼痛症状、患者足底应力变化、足部功能改善情况进行比较分析。结果：两种手术前后疼痛缓解均有显著性差异,以Weil截骨组疼痛缓解更明显,但两组间疼痛缓解无明显统计学差异。两组患者手术前后患趾跖骨头下应力峰值明显下降。Weil截骨组,手术前后立位时和足跟抬高时的病变跖骨头下应力分别下降35％和51％;Jacoby截骨组分别下降25％,n45％。根据美国足踝外科协会Maryland跖趾关节百分评分法对两组患者进行评定：优,A组24足（占75％）,B组22足（占71％）;良,A组6足（占18．8％）,B组5足（占16．1％）;可,A组2足（占6．2％）,B组4足（占12．9％）。A组优良率为93．8％,B组为87．1％。结论：对于应力性跖痛症患者,跖骨远端Weil截骨术与Jacoby截骨术治疗均可取得满意确切的效果。但weil截骨术手术操作技巧要求更高,Jacoby截骨术对初学者更易掌握。临床需要根据患者的实际情况及个体需求灵活选择。     

Weil截骨术治疗原发性跖痛症的短期临床效果评价

目的观察Weil截骨术治疗原发性跖痛症的短期临床效果。方法自2011-04—2013-05采用Weil截骨术治疗原发性跖痛症39例(48个跖骨头),切开、松解跖趾关节囊,避免损伤关节软骨,并将近节趾骨完全跖屈,彻底显露跖骨头,用摆锯自跖骨头关节面背侧下方2 mm沿足底负重平面向近端跖侧截骨,将远端跖骨块向近端平行推移,用直径1.5 mm克氏针由跖骨近端向跖骨头临时固定,用1枚直径1.7 mm皮质骨钉最终固定。比较术前及术后3个月跖骨绝对长度、跖趾关节活动度、VAS评分、AOFAS评分。结果本组均获得随访7~24个月,平均15.2个月。截骨后跖骨平均缩短3.88 mm。所有患者术后无切口感染及截骨延迟愈合,跖侧疼痛均明显改善。关节间隙维持,患足外观正常,无转移性跖骨下疼痛。所有患者术后跖骨绝对长度缩短、跖趾关节活动度减小,但VAS评分明显降低、AOFAS评分明显升高,差异均有统计学意义(P0.05)。结论 Weil截骨术治疗原发性跖痛症短期临床疗效显著,是一种可靠的术式。长期疗效有待进一步观察。     

Weil osteotomy: Assessment of medium term results and predictive factors in recurrent metatarsalgia

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.     

Sliding osteotomy for metatarsalgia

We reviewed the results of treatment of 27 feet in 21 patients with pressure metatarsalgia treated with a distal oblique metatarsal osteotomy performed according to the technique of Helal. The median age at the time of operation was 52 (30–75) year, with a median follow-up of 6 years and 9 months (3 1/2–10 1/2 years).The over-all results were good in 12 feet, fair in two, and poor in 13 of the feet. Patients experienced some degree of improvement in 21 feet, and for 20 feet the patients stated they would have agreed to surgery if they had known the outcome in advance. There were non-unions in three feet, transfer lesions in nine, and recurrent lesions in seven.We can not confirm the good results after Helal's osteotomy reported by some other authors. Patients should be fully informed of the uncertain outcome before submitting to surgery for metatarsalgia.     

Metatarsal osteotomy for metatarsalgia.

An oblique osteotomy in the distal half of the metatarsal shaft is described for the treatment of metatarsalgia due to prolapse of one or more of the middle three metatarsal heads. Thirty-eight patients who have had this operation have been followed up for a period of from two to five years. The operation is simple, recovery is rapid and symptoms have been well relieved.     

Metatarsal neck osteotomy for metatarsalgia

Surgical principle This osteotomy is performed to relieve the pressure exerted by one or more metatarsal heads on the overlying sole of the foot. This pressure can lead to painful plantar callosities. Through a transverse dorsal approach a V-shaped notch down to but not including the plantar cortex is created with a small rongeur. Through manual osteoclasia the head is tilted upward. Full weight bearing helps to maintain the metatarsal head in the corrected position. No internal fixation nor external immobilization are needed.      

Metatarsal neck osteotomy for metatarsalgia

Surgical Principles This osteotomy is performed to relieve the pressure exerted by one or more metatarsal heads on the overlying sole of the foot. This pressure can lead to painful plantar callosities. Through a transverse dorsal approach a V-shaped notch down to but not including the plantar cortex is created with a small rongeur. Through manual osteoclasia the head is tilted upward. Full weight bearing helps to maintain the metatarsal head in the corrected position. No internal fixation nor external immobilization are needed.     

The Weil osteotomy: a seven-year follow-up

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.     

Complications of the Weil osteotomy

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.     

Weil截骨治疗(足母)外翻转移性跖痛

[目的]回顾分析Weil截骨治疗(踇)外翻转移性跖痛的疗效.[方法]自2004年至200:5年联合应用第1跖骨基截骨及Weil截骨治疗伴有外侧跖骨头转移性跖痛的中重度外翻17例25足.患足手术前后常规拍摄足正侧位片,测量足母外翻角(HVA),I-Il跖骨间角(IMA),使用美国足踝外科协会(踇)趾-跖趾-趾间关节评分系统(AOFAS)评分评估临床疗效.手术方法根据患者术前症状选择第1跖骨基底截骨联合外侧跖骨头Weil截骨.[结果]患者(踇)外翻角(HVA)术前为32°±5.7°,术后为12.8°±3.5°;Ⅰ-Ⅱ跖骨间角(IMA)术前为23.2°±3.7°,术后为10.5°±0.7°;AOFAS评分术前45.6±6.9分,术后86.9±4.6分;Weil截骨术后的跖骨短缩3-8 mm,平均4.5 mm;术后18足跖痛症状完全缓解,7例好转,所有患者日常生活正常,无需进一步治疗.[结论] (踇)母外翻术前应综合分析足部的生物力学变化,对伴有外侧转移性跖痛的严重(踇)外翻患者,联合使用第1跖骨基截骨和外侧跖骨头Weil截骨可获得良好疗效.     

Geometric analysis of the Weil osteotomy

BACKGROUND: The Weil osteotomy has been reported to be a clinically effective treatment of metatarsalgia and intractable plantar keratosis. The plantar inclination of the metatarsal influences the effect of the osteotomy but has never been studied in detail. METHODS: This study examined five fresh or fresh-frozen cadaver specimens. The data obtained from the specimens was used to model the geometry of the Weil osteotomy. The effect of thick saw blades on the Weil osteotomy was determined. RESULTS: The inclination of the second metatarsal averaged 24.6 (range 19 to 31) degrees. The displacement of the capital fragment in the plantar direction was dependent on the angle of the osteotomy and the inclination of the metatarsal. A 5-mm proximal displacement along a 25-degree osteotomy displaced the capital fragment in a plantar direction if the inclination of the metatarsal was 19 degrees and displaced it dorsally if the inclination was 25 degrees or more. CONCLUSIONS: The results of this study showed that a thick saw blade could offset a portion of the plantar displacement of the capital segment that can occur with the Weil osteotomy. A 1-mm thick saw blade is recommended for most osteotomies, and a 2-mm thick saw blade is recommended for shortening of more than 5 mm or with plantar inclination of the lesser metatarsal of less than 19 degrees. A thicker saw blade should be considered for the treatment of plantar keratosis.     

The Weil osteotomy for the treatment of painful plantar keratoses

Management of painful plantar corns remains challenging. Failure of conservative treatment may necessitate surgical intervention. The aim of this study was to assess the effectiveness of the Weil osteotomy in the treatment of painful plantar corns. A total of 29 patients (33 feet) underwent Weil osteotomy combined with plantar lesion excision of a single metatarsal of either the second, third or fourth metatarsals. These were reviewed post-operatively at an average of 42.4 months. At final review, nine feet (27%) presented with a corn. Four feet (12%) developed transfer metatarsalgia with a total of seven feet (21%) requiring revision surgery. The average metatarsal shortening was 4.5 mm. Requirement for regular clinical lesion reduction fell from an average of 5.6 weeks to 12 weeks (P<0.001) between treatments and the American Orthopaedic Foot And Ankle Society clinical rating scale improved by an average of 48 points (P<0.001). The Weil osteotomy is a moderately effective intervention which should be considered in planning the treatment of intractable plantar corns.     

The Weil osteotomy for correction of the severe rheumatoid forefoot

Purpose

In rheumatoid arthritis the metatarsophalangeal (MTP) joints are predominantly affected with resultant metatarsalgia and dislocation. Therapy options include many different surgical procedures with results that are not always satisfying. We present the oblique Weil metatarsal osteotomy as a treatment option for the rheumatic forefoot.

Methods

A total of 216 osteotomies in 63 consecutive patients (72 feet) with a mean age at the time of surgery of 59.3 years and long-standing rheumatoid arthritis were observed prospectively for an average of 57.4 months (minimum 36 months). All patients received a Weil osteotomy of the lesser metatarsals with at least one additional procedure of the forefoot. Patients were evaluated prospectively for clinical outcome by the American Orthopaedic Foot and Ankle Society (AOFAS) lesser MTP-interphalangeal scale and subjective satisfaction. In the radiological evaluation weight-bearing X-rays were analysed for alignment, shortening and union.

Results

American Orthopaedic Foot and Ankle Society score increased significantly from 21.9 ± 6.7 to 63.3 ± 9.8 (p < 0.05). The increase was significant for all subgroups regarding pain, function and alignment. All joints were dorsally dislocated preoperatively; a subluxation was present in 13.6 % at follow-up. There was a significant decrease of callositas in 82 %, a decrease in need for orthopaedic shoes in 61 %, a decrease of MTP joint stiffness in 96 % and a relief of severe pain in 97 % of all patients. No metatarsal head dislocation or necrosis, pseudoarthrosis or screw perforation was observed. Of 63 patients, 55 (88 %) subjectively reported excellent or good results.

Conclusions

We conclude that the Weil procedure for lesser metatarsals is a satisfactory method for correcting the rheumatic forefoot and can be recommended as an approach for the future.     

Management of metatarsalgia using Helal's method for metatarsal osteotomy]

Authors report on the result of Helal's metatarsal osteotomies performed on 62 feet of 48 patients for metatarsalgia. In 85 per cent the result proved to be excellent, in 15 per cent there was no improvement. Analysing the causes of the postoperative complaints they call attention to the overload of the marginal arches and to the metatarsalgia developing on the non osteotomized neighbouring arch. These complaints appeared in 1/3 of their material and could be generally well influenced with conservative treatment.