Weil Metatarsal Shortening Osteotomy

2nd Metatarsal Shortening Osteotomy

Indications

Metatarsalgia describes pain in the region of the ball of the foot (metatarsal heads), this region at the base of the toes takes load when pushing off, standing on the toes or wearing shoes with a heel. On occasion, one or more of the metatarsal heads may take greater load than the others causing pain. This is called metatarsalgia. This is worsened by activities that place extra load on this area such as standing on tip toes, wearing high heels or walking on hard surfaces. Metatarsalgia may be associated with toe deformities such as claw or hammer toes as well as a long metatarsal (usually the second). Treatment is initially non-operative such as shoes, inserts and analgesia. Failure of non-operative management can lead to surgery involving a Weil osteotomy.

A Weil metatarsal is a surgical procedure to cut (osteotomy) and shorten the metatarsal bone. It is performed to decrease pressure on a prominent metatarsal head in the forefoot.

Procedure

A Weil Osteotomy is performed by making an incision over the base of the second (or other involved) toe. The surgeon exposes the far (distal) end of the involved metatarsal, the metatarsal head and the neck. A saw is then used to cut the bone parallel to the sole of the foot. This allows the metatarsal head to be shifted backwards towards the heel, approximately 3 to 5 mm, though in some cases even farther. It is also possible to remove a small section (1 to 3 mm) of bone to help elevate the bone so that the metatarsal head is not as prominent. The metatarsal head fragment is then stabilized in the new position with one or two small screws or pins.

Recovery

After the surgery, the bone that has been cut needs to heal. Therefore, protected weight bearing (through the heel only) in a post operative shoe or walker boot is indicated for a period of usually six weeks, which allows the healing to occur. Stitches are often removed 10 to 14 days after surgery. This procedure is often done in conjunction with other procedures (example bunion procedures or claw toe corrections), and often the recovery protocol needs to be consistent with the other procedures. It is often at least 6-12 months before a full recovery is obtained.

Potential Complications

A Weil Osteotomy has the usual potential complications, including:

In addition, there are some specific potential complications associated with this procedure. Complications that are specific to the Weil Osteotomy include:

Stiffness of the joint at the base of the associated toe (ex. 2nd MTP joint)- This joint tends to be stiff as there is a tendency to form a significant scar in this area. The toe may also rise up somewhat.
Associated pain in other areas- Occasionally, by shortening or repositioning this bone, weight is shifted to another bone, and symptoms can occur in this area.
Vascular injury– Very rarely the blood supply to the tip of the toe will be lost in the surgery and this can lead to necrosis and even loss of the tip of the involved toe. This is especially true if there is a significant claw toe that is straightened or there has been previous surgery in the area.
Non-union– Occasionally the bone that is cut will not heal.
Malunion– Occasionally the bone will heal in an inappropriate position that can affect the symptoms.
Painful hardware– If screws are used, these may become prominent and irritate the associated soft tissue or tendons in the area. Occasionally they will need to be removed.

Edited July 3, 2020

Previously edited by Daniel Guss, MD and Justin Greisberg, MD)

mf/1.29.18