The Weil Osteotomy in Metatarsalgia

The surgical treatment of static pain in Metatarsalgia II – IV and its MTP joints using the Weil osteotomie, has over the last 10 years become an increasingly accepted method. As one would aspect, it is used in the bone correction treatment of the so-called “Overload-syndrome” of the lateral metatarsal head and joint. This is usually the result of a transfer metatarsalgia, with the accompanying hallux valgus. The most common cause of which is the compression of the hallux valgus to the lateral toes combined with an over-length of the lateral metatarsal. The metatarsal pain syndrome generally precedes a chronic degeneration of the plantar plate under the lateral MT heads. The continual static and functional strain leads to a chronic pressure or stretching of the plantar plate. This can cause its decompensation or rupture. Than the metatarsal head pushes through the plantar plate rupture and causes pain and plantar callosities by direct pressure under the skin. With stretching or rupture of the collateral tendons and the capsule an “Intrinsic over pull” results. This collapses the MTP joint function and develops into a sub-/luxation of the MTP-joint and chronic joint capsule pain. X-rays of the fully weight-bearing foot will record the form and position of the MTP joint and the true relative length of all metatarsal in conjunction with one another. Normal anatomical length must be compared with pathological variations to enable recognition of pathological entities of the forefoot, as changes after a previous operation, trauma, Freiberg disease or congenital short metatarsal. These conclusions may be obtained using the Metatarsal-Index (MI) (Morton 1948, Debrunner et al. 1977, Maestro 1994). The MI is defined by using the absolute length of the first metatarsal. In Metatarsal Index minus the 1st metatarsal is shorter than the 2nd. The MI is surgically implemented to align the metatarsal, thus achieving the best weight transfer onto the front of the foot (LeLi�?vre, 1971). With the surgical shortening and achieving a physiological arch of the metatarsal, pressure upon the metatarsal head and the MTP joint can be relieved. The MTP joint luxation or subluxation and secondary non contracted claw deformities, caused by “Intrinsic over pull“, can efficiently be reduced as well. Thus bone alignment of the pathology and metatarsal parable in the area of MTP joints can be reconstructed and corrected in a controlled and pre-planned operation. Our experiences show that this method can successfully be used to reduce overload pressure on the MTP head and joint following the Metatarsal Index minus. We perform this technique in metatarsalgia by shortening the metatarsal and to realign the disorder of M I after trauma, inherited short metatarsal and as a modification of the dorsal wedge-resection osteotomy, in case of Freiberg disease. Furthermore this technique is recommended in cases of secondary transfer metatarsalgia, after operations with shortened 1st metatarsal (metatarsal osteotomy, Hueter-Majo, Keller procedure et al) and after isolated resection the lateral metatarsal heads.