The Weil Osteotomy for Subluxated or Dislocated Metatarsophalangeal Joint

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For metatarsalgia caused by a sublaxated/dislocated lesser metatarsophalangeal joint (MTP joint) surgical treatment options without sacrificing the joint are limited. The Weil osteotomy is an oblique osteotomy of the metatarsal neck and shaft, which provides controlled shortening of the metatarsal and has been recommended for painful subluxated/dislocated MTP joints. This procedure offers many advantages over more traditional osteotomies, including stability in the large area of the bone to bone contact with easy internal application. Clinical results of the Weil osteotomy have been very promising. A low dislocation rate along with significant pain reduction, disappearance of plantar callosity and increased ambulatory capacity has been achieved. Complications mentioned in literatures are floating toes, stiff toes, postoperative extension contracture, and limitation of range of motion of the MTP joint. Several soft and bony interventions like lengthening of the extensor tendon, bony slice extraction and inserting a temporary Kirschner-wire from the tip of the toe across the MTP joint and the osteotomy into the metatarsal may prevent postoperative dorsiflexed contracture in severe subluxated MTP joints.

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