Floating-toe deformity as a complication of the Weil osteotomy.
BACKGROUND
The Weil osteotomy for treatment of central metatarsalgia is an oblique osteotomy of the metatarsal neck and shaft parallel to the ground that provides controlled shortening of the metatarsal without additional depression. It offers many advantages over more traditional osteotomies, including stability and a large area of bone-to-bone contact. However, a floating-toe deformity appears to be a common complication after this osteotomy.


METHODS
Between February, 2000 and February, 2003, 70 Weil osteotomies (in 26 patients) were done at one institution. Follow-up averaged 18.3 (6 to 36) months. Weightbearing radiographs were examined for shortening, subluxation, and for evidence of nonunion or malunion of the metatarsal head. Floating-toe deformity and mild recurrent tenderness were noted in the history and physical examination. The American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Metatarsophalangeal-Interphalangeal Scale (LMIS) was used for outcome rating. At final follow-up, nonunion and malunion also were evaluated.


RESULTS
The median score of the AOFAS scale was 81 (19 to 95) points. Fifty-four percent of the osteotomies were done with a proximal interphalangeal (PIP) joint arthrodesis of the same ray, and we observed a higher occurrence of floating-toe deformity in this group of patients.


CONCLUSIONS
Although it may be associated with some complications, the Weil osteotomy is an effective and safe procedure for the treatment of central metatarsalgia. We conclude that floating-toe deformity is a common complication associated with PIP joint arthrodesis. Although it appears not to cause a functional impairment, concurrent PIP arthrodesis should be avoided to reduce the occurrence of floating toes.
Migues
Atilio
A
Hospital Italiano de Buenos Aires, Department of Foot and Ankle Surgery, Buenos Aires, C1199ACK, Argentina.
Slullitel
Gaston
G
Bilbao
Facundo
F
Carrasco
Marina
M
Solari
Gabriel
G
D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D005531:Foot Deformities, Acquired / Q000209:etiology*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D037061:Metatarsalgia / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods; D014033:Toe Joint / Q000601:surgery