indications and technique of the weil osteotomy - The Podiatry Institute

12CHAPTER 3dorsiflexed toe that is released may benefit from a 0.045K-wire across the MTP joint for 4 to 6 weeks. In mildercases, splinting or a Betadine splint is useful for the initialthree weeks. The patient should initiate rigorous sagittalplane exercises once early bone healing has occurred.The most common reported complication is thefloating toe. One theory suggests the Weil osteotomychanges the center of rotation of the MTP joint. Theinterosseous muscles then act more as dorsiflexors thanplantarflexors contributing to a nonpurchasing toe. Iusually will perform a proximal interphalangeal jointarthrodesis in concert with a Weil osteotomy whenindicated. I strive to avoid excessively shortening the toewhile performing the arthrodesis to preserve the strongerplantarflexory lever arm associated with an arthrodesis.The arthrodesis should be mildly flexed by bending theK-wire after it is inserted into the toe. In addition, the longextensor tendon is lengthened in a Z-plasty fashion as areall of the soft tissues that are dorsally contracted with thesequential release. A K-wire can be carefully passed acrossthe reconstructed metatarsophalangeal joint to either sideof the screw when necessary. These measures greatlydecrease the incidence of a nonpurchasing toe.Significantly unstable, dorsiflexed toes will require aconcomitant flexor tendon transfer.The Weil osteotomy is an effective and safe procedurefor the treatment of plantar, central metatarsal symptomscaused by a relatively long metatarsal. Complications can becontrolled with a judicious amount of shortening ofthe metatarsal while avoiding plantar depression of thecapital fragment. Ancillary procedures directed at correctingcoexistent pathology must be considered in compounddeformities.