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A “lost” comment

I apologise for having lost a comment from a podiatrist. If he could repost I would be appreciate.

My comment was as follows:

Thank you for your interest, I admire your assiduous pursuit of the best for you patients.

Risk needs be assessed in terms of frequency, and one function of the surgeon is to know that and make his own.

I think that I have posted a comment on the paper “Foot Ankle Surg. 2011 Sep;17(3):150-7. Epub 2010 Jul 9. Weil osteotomy: assessment of medium term results and predictive factors in recurrent metatarsalgia”

You use the analogy with the hip. In fact most hips survive until death even in nonagenarians. Only a fraction of human hips need replacement. Further, a hip arthritis might be unilateral and one must then ask why one went wrong and the other did not. The answer is unknown, but as illustrate it is clearly cannot be “age, wear and tear”.

If I extend that argument to a “long” metatarsal, it is not abstract to appreciate that such a metatarsal has worked well for the greater part of the patients life,  probably on both feet. Therefore there must be some other factor which has intervened and caused that ray to become painful, particularly if  one ray on only one foot is symptomatic. What is “abstract” is for surgeon to pick a long metatarsal, blame the pain on its length and shorten it. Indeed probable more often than not the deformed and painful ray could be one of the shorter metatarsals. The metatarsal shortening enthusiasts will then go ahead and shorten that “short” metatarsal.

Hallus rigidus and hallux valgus are very different pathologies, and the reason for the difference has been well assessed.

Weil osteotomy was born out of the failure of all other approaches. Remember that that before the Weil surgeons were convinced that they were doing the “right things”, and justified their conviction by a “rationale”. The rational currently used to justify the Weil is equally unconvincing to me.

The explanation and descriptions of the pathologic evolution of forefoot deformities (and flowing from that the treatment) has taken me some time, given that I have set myself a minimum (and large) number of patient in the study with a minimum follow up of 25 years. Hence the delay.

Best Wishes

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