The Weil Osteotomy for Angular Correction of Axial Plane Deformities of the Lesser MTP Joints: A Radiographic Analysis

Abstract

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: The oblique shortening (Weil) osteotomy of the distal metatarsal neck has been described as an effective means of correcting lesser toe metatarsophalangeal joint deformity. Previous studies have focused on clinical outcomes, complications, and the magnitude of plantar displacement and shortening. The aim of this study was to quantify the magnitude of axial plane correction obtainable when a medial or lateral displacing Weil osteotomy was used in conjunction with other procedures in forefoot reconstruction surgery. Methods: Consecutive patients with a minimum 12-month follow-up who were treated by the senior surgeon from January 1, 2008, to September 1, 2018, were included. Review of the medical records identified 234 toes in 190 patients that had medial or lateral displacement Weil osteotomies as a part of their treatment for metatarsalgia and lesser toe deformity. Concomitant procedures were recorded. Pre- and post-operative weightbearing radiographs were analyzed to determine the amount of transverse plane change and residual varus/valgus alignment. Radiographs were then classified as good (15 degrees). Any worsening of the post-operative alignment compared to the pre- operative alignment was noted. Follow-up notes were reviewed for clinical observations of floating toe, resting alignment, persistent pain and swelling at 3 months, complications, and need for revision surgery. Results: The average transverse plane correction was 12.5 degrees (range 0-45 degrees). Most toes remained in some degree of radiographic varus or valgus alignment as a true neutral toe was rare. Over a third, (35%, n=81) had increased postoperative angulation; 42% of radiographs were graded as good alignment (n=99), 20% as intermediate (n=46), and 38% as bad (n=90). The most common concomitant procedures were PIP joint resection arthroplasty and distal chevron bunionectomy. Review of clinic notes revealed low incidences of floating toe (7%, n=16), clinical malalignment (8%, n=18), and need for revision surgery (3%, n=8). Persistent swelling was the most common complication, present in 44% of patients at the 3-month follow-up. Conclusion: The medial and lateral displacing Weil osteotomy can be a powerful tool to correct lesser toe MTP joint transverse plane deviation. It was typically used with PIP joint resection and hallux valgus procedures to improve the lesser toes and overall forefoot alignment. Interestingly, most toes had a neutral or good clinical alignment regardless of the radiographic alignment. Further studies to correlate radiographic and clinical outcome measures may help define its role in correcting lesser toe deformity.