The Weil osteotomy of the lesser metatarsals: a clinical and pedobarographic follow-up study

The clinical results with pedobarographic analysis were assessed in 32 pati ents (59 metatarsals) who underwent a distal metatarsal shortening (Weil) o steotomy for either intractable plantar keratoses or chronically dislocated lesser metatarsal phalangeal joints. All patients had increased pressure u nder the involved metatarsal heads. Thirty three of the 59 metatarsophalang eal (MTP) joints were chronically dislocated. At an average follow-up of 30 months, patients rated the result as excellent or good for 32 of the 37 fe et (86%). The mean preoperative AOFAS score was 59 (maximum Inn), which imp roved to 81 postoperatively. This difference is significant : p= 0,00001 (w ith t-test). Comparison of the pre and post-operative pedobarographic measu rements showed a significant decreased load under the affected metatarsal h eads (p = 0.05). A complete disappearance of the callus was noted under 44 operated metatarsals (75%) and partial disappearance under 12 metatarsals(2 0%). Two symptomatic transfer lesions occurred under an adjacent metatarsal head. Recurrent dislocations occurred in 5 joints(15%). While metatarsopha langeal joint range of motion was significantly diminished, toe strength wa s maintained. Average metatarsal shortening was 5.9 mm with no nonunions, d elayed unions, or malunions. The Well shortening osteotomy is a simple and reliable procedure which can effectively reduce the load under the lesser m etatarsophalangeal joints and is helpful for the reduction of dorsally disl ocated MTP joints.