Advances in the Causes and Treatment of Floating Toes after the Weil Osteotomy: A Scoping Review

Abstract

The floating toe deformity is classified as a forefoot deformity wherein the distal portion of the toe does not establish touch with the ground, resulting in a suspended or elevated position while the finger is in a relaxed state. At first, it garnered considerable interest as a complication It is worth noting that this condition is particularly common in children under the age of 8, which usually disappears as the individual reaches maturity. Studies have shown that with the aggravation of floating toe deformity, its adverse effects on patients' gait and overall quality of life also increase. Despite the prevalence of floating toe deformity in clinical settings, there is a lack of comprehensive literature investigating its underlying causes and potential preventive strategies. This scope review follows the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) statement guidelines for scope reviews. The literature was obtained from various full-text databases, including China National Knowledge Infrastructure Database (CNKI), Wanfang Database, PubMed, and Web of Science Database. Our search focused on published literature related to floating toes, Weil osteotomy, and distal metatarsal osteotomy, up until March 1, 2023. The literature search and data analysis are conducted by two independent reviewers. If there are any disagreements, a third researcher will participate in the discussion and negotiate a decision. Furthermore, two experienced foot and ankle surgeons conducted a thorough literature analysis for this review. Sixty-two articles were included. Through the clinical analysis of the structural changes of the forefoot before and after operation, the classification of floating toe was described, the causes of pathological floating toe were summarized, and the possible intervention measures for the disease were put forward under the advice of foot and ankle surgery experts. We comprehensively summarize the current knowledge system about the etiology of floating toe and put forward the corresponding intervention strategy. We recommend that future studies will focus on the improvement of surgical procedures, such as the combination of Weil osteotomy, proximal interphalangeal (PIP) arthrodesis and flexor tendon arthrodesis.

Keywords: Distal metatarsal osteotomy; Floating toe; Interventions; Surgical complications; Weil osteotomy.

FIGURE 1

Literature screening flow chart.

FIGURE 2

Architectural marks: Pictures for relative differences in four metatarsal lengths that can be conceptualized as an isometric sequence with a constant ratio of 2.

FIGURE 3

Rotation center of the metatarsophalangeal joint shifted down the determination of the center of rotation of themetatarsophalangeal joint was achieved through the use of three points on the metatarsal head. Point A is the central point of the articular surface of the metatarsal head, in the same straight line as the longitudinal axis of the proximal phalanx. Point B corresponded to the lower (plantar) and more proximal edge of the head before its transition to the plantar surface of the neck. Point C is the dorsal highest point of the metatarsal head.

FIGURE 4

Weil osteotomy anatomic positions. The shortening of the metatarsal bone causes a relative lengthening of the tendon and ligaments.

FIGURE 5

Proximal interphalangeal (PIP) joint arthrodesis of Toe 2.

FIGURE 6

An atomical interpretation of the modified Weil osteotomy.

FIGURE 7

Anatomical interpretation of the triple Weil osteotomy.