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Chapter 21: Weil Osteotomy

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by

Ameet Thakrar

on 20 October 2014

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Transcript of Chapter 21: Weil Osteotomy

maintain collateral during extensor hood/capsule dissection
If osteotomy is too long for saw blade use osteotome
metatarsal head may rotate as screw is being tightened.2 points of fixation will prevent this
Usually a 12 mm screw will fit an Adult foot without breaching plantar cortex
If the toe is dorsally subluxed, too much shortening will weaken flexors/intrinsics. Consider Flexor tendon transfer.
Complication
Most common complication:
"floating toe" caused by over powering of exensors and excess laxity of flexors + fascia. giving toe a dorsiflexed attitude. This exacerbated by formation of dorsal surgical scar formation.
Severely plantar flexed met. This cut may promote plantar flexory strength by reorientation of interossei in relation to joint axis
Overall physical examination must include evaluation of concomitant deformities especially hammer toes, hallux valgus, 1st ray hyper mobitlity.
Non purchasing toe is a complication that is associated with PIPJ arthrodesis in combination with Weil's osteomtomy.However there does no seem to be fxnal impariment
Contraindications
* non of these are absolute contraindications
severe sensory neuropathy
poss of surg induced charcot
severe PAD
Again no specific contraindication which makes the procedure dynamic
Indications
recalcitrant metatarsalgia, refractory to conservative care.
Long metatarsals w& w/o transverse plane digital deformities
crossover toes & dislocations/subluxation @ MTPJ
Rheumatoid Deformities @ MTPJ
Pearls/Pitfalls
Preoperative considerations
Indications/contraindications
Chapter 21: Weil Osteotomy
Presented by: Thakrar

Background

Lowell Weil,sr described the osteotomy in 1992, 1st to say it should be parallel to WB surface DD->PP

Gained popularity in Europe and then began to gain traction in North America.

There are > 25 procedures described for the lesser Metatarsals MCC unwanted excessive dorsiflexion or planterflexion
Be conscious of the metatarsal parabola. shortening 1 of the lesser metatarsals may transfer undue pressure on the subsequent metatarsal. Multiple Weil's may be meritted
A. incision btwn 2& 3rd metatarsal.Followed by blunt dissection
B. the hood and dorsal capsule are incised btwn the long and short extensors of the 3rd ray.
D.Ext Tendons retracted. *
Osteotomy is 1-2 mm inferior to the most dorsal portion of the articular surface. Osteomtomy parallel to WB surface. Cut overhang after fixation.
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