The Conventional Weil Osteotomy Does Not Require Screw Fixation

Abstract

The Weil osteotomy is an established procedure to reduce plantar pressure in chronic metatarsalgia. Historically, the refixation of the displaced metatarsal head is performed by screw fixation. We aimed to demonstrate that screw fixation is not always necessary. Between 2016 and 2021, 155 patients with 278 Weil osteotomies (20 males and 135 females, mean age: 63 years) were retrospectively enrolled. Group A (n = 96) underwent 195 Weil osteotomies with screw fixation; group B (n = 59), 83 without screw fixation. Demographic, Visual Analog Scale Foot and Ankle (VAS-FA), SF-12 questionnaire, and toe mobility data were recorded. The mean follow-up period was 4.5 years. The mean VAS-FA was 75.5; mean SF-12 physical component summary, 42.0; and mean SF-12 mental component summary, 51.0. The overall revision rate was 20% (group A: 25%, group B: 10.2%), primarily for arthrolysis of the metatarsophalangeal joint in group A. Clinical comparisons showed no significant difference between the groups (p > 0.05). The revision rate was significantly higher in group A (p < 0.05), with equal satisfaction in clinical outcomes. Based on the available data, the need for regular screw fixation after a Weil osteotomy cannot be justified.

Keywords: Weil osteotomy; claw toe; flat-cut; metatarsalgia; screw fixation; wedge-cut.

Figure 1

Pre- and postoperative radiographic findings of combined Weil osteotomy (group A with screw) and hallux valgus surgery, left foot. (a) Anteroposterior view preoperative, (b) anteroposterior view 3 months postoperative.

Figure 2

Study flow chart.

Figure 3

Weil osteotomy in wedge-cut technique.

Figure 4

Pre- and postoperative radiographic findings of combined Weil osteotomy of metatarsal 2 (group B without screw) and hallux valgus surgery, left foot. (a) Anteroposterior view preoperative, (b) anteroposterior view 6 weeks postoperative.