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The Weil osteotomy

The Weil osteotomy (cutting of bone) was developed by LS Weil to treat “static disorders” of the lesser toes. The term “static disorder” is perplexing since the forefoot is in all respects a dynamic structure. The purpose of the procedure is to shorten a metatarsal in the management of pain in the sole of the foot, “metatarsalgia”.     The rational escapes me.

There are no random controlled trials comparing this with any other procedure. Isolated reports recognise the following complications. I have listed the highest reported complication rates. [I believe the patient must be informed of, and assume, the worst outcomes]

Floating Toes: 68% (Hoffstaetter 2006)

Stiffness 40% (Barrie and Watmough)

Persisting pain 27% (Davis and Saxby 1999, short term follow up)

Uncorrected dislocation 15%

Transfer lesions 6% (Vandeputte 2000)

Other complications reported include

Infection

Screw Migration

Persisting sub-metatarsal callosities

Hypertrophic incision scar

Deep vein thrombosis

Complex regional pain syndrome

Displacement

Delayed union

Period of convalescence 3-4 months

Off work – 6 weeks for standing occupations (and presumably for public transport commuting)  http://www.londonfootsurgery.com/weil_osteotomy.html

 

Barrie and Watmough (2008) report “Overall patient satisfaction of about 90%”. This is difficult to reconcile with the above figures, even if it is supposed that all the complications occurred in the same patients, which is improbable. The more likely explanation is that patients became reconciled with their disabilities.

Correspondence from advocates of the procedure would be welcomed.

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