Weil Metatarsal Shortening Osteotomy

Indications

A Weil metatarsal shortening osteotomy (bone cut) is performed to decrease pressure on a prominent metatarsal head in the forefoot. The metatarsal head is the portion of the metatarsal bone that articulates (forms a joint) with the base of the toe. When the metatarsal is long or is positioned in such a way that the associated metatarsal head is taking a disproportionate amount of weight, pain can occur. This source of pain in the forefoot is called metatarsalgia. A long or prominent metatarsal bone usually affects the second and, occasionally, the third metatarsal. It is often associated with a claw toe deformity of the involved toe. As the toe claws, it pulls forward the cushioned fat pad normally present in the forefoot, uncovering the metatarsal head and further exposing it to pressure.

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, weight bearing or protected weight bearing (through the heel only) in a surgical 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 four to six months before full recovery is obtained.

Specific Complications:

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 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.
Non-union– Occasionally the bone that is cut will not heal.
Mal union 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.