Fact sheet 17 Metatarsal (lesser) osteotomy for forefoot and toes

The operation

·  Known as a Weil or proximal displacement osteotomy

·  The lesser metatarsals form the smaller four outside long bones in the foot.

·  Often the three central bones will need an operation together

·  The bone lengths will be better positioned

·  You will be advised in advance for this type of operation.

·  Cuts are made into the bone which is fixed with a screw (illustrated)

·  A scar line will be visible on top of the foot

Aim

·  Often combined to straighten a lesser toe

·  To shorten or elevate the head of the bone pressing on the ball of the foot

·  Alleviate pressure from a long-standing corn, callus, bursitis or to improve the position of the bone

·  Can be used to aid a dislocated toe associated with a bunion

Diagram taken from Clinical skills in treating the foot. Tollafield & Merriman 1997/2005. Unwanted toe sticking up 1-6% risk. Taping is important.

After the operation / Things you need to know
Sometimes a wire stick out of the toe with a small protective ball on the end while screws are not visible / Shoes - expect about 8-12 weeks to get back into most shoes. Buy larger deeper shoes with soft uppers.
Early foot contact is usually quite quick at 3 days but comfortable pressure may take 3-6 weeks / A corn may develop over the bone next to the operation (8% chance) of ONLY one bone is operated on. The risk will be discussed.
Return to work 3-4 weeks / Numbness around the toes
Infection less than 1% chance
Casts are not usually used unless you need to put more pressure down or have lots of swelling / When used with a corn it may not clear completely (63% chance of helping without plastic skin surgery but should reduce in size and symptoms).
The toe may need to be taped down for 3 months to stop lifting or contraction, an undesirable effect. Risk 6% Illustrated. / Swelling may reduce over 12 months
Scar formation is very common around the joint between the toe and foot and movement may remain stiff. Risk 2% / Complex regional pain syndrome low risk but can arise with multiple bone surgery more than single toe surgery
Driving again at three weeks + / Scar Tenderness low risk
Benefit 68% effective treatment / Revision surgery required small risk
76% chance of being better than before / Healing or stitch problems up to 3% risk

Data taken from research - source Tollafield, D R presented to the National Podiatry Conference at Bristol 1996 Tollafield D R 2001

An audit of lesser metatarsal osteotomy by capital proximal displacement (Weil Osteotomy) British Journal of Podiatry 4,1:15-19

Data are supported by the national data base PASCOM-10 for 250 procedures

Consultingfootpain. Podiatric surgical services. Mr D R Tollafield

0121 353 2444