The Weil Lesser Metatarsal Osteotomy

The Weil Lesser Metatarsal Osteotomy

Richard J. Zirm

The Weil osteotomy has become a popular technique for the surgical treatment of resistant lesser metatarsalgia. Metatarsalgia is a vague term that represents tenderness and pain in the plantar forefoot. The etiology varies widely from soft tissue to osseous, with neurologic, vascular, or dermal manifestations. It is a common presenting complaint that can interfere with normal ambulation, work, fitness, and recreation.

There is a considerable body of literature attesting to both the effectiveness and complications of this osteotomy. Bevernage and Leemrijse et al (1) studied 63 patients (73 feet and 177 metatarsals) with persistent metatarsalgia who underwent forefoot reconstruction by Weil osteotomies intended to restore a more normal metatarsal parabola. Sixty-two (85%) of the 73 feet were pain-free after recovering from surgery. The mean preoperative AOFAS score of 36.2 improved to 82.2 postoperatively. The mean metatarsal shortening was 5.71 mm. Preoperative metatarsophalangeal joint (MTPJ) luxation was 30%, whereas postoperative luxation was 8.24%.

Vandeputte et al (2) documented the average metatarsal shortening to be 5.9 mm with 59 operative metatarsals in 32 patients. Postoperative metatarsophalangeal motion was significantly diminished; however, toe strength was maintained. There were no nonunions, delayed unions, or malunions.

Hofstaetter et al (3) concluded that the Weil osteotomy significantly reduced plantar forefoot pain, diminished isolated plantar callous formation, and increased the patient’s capacity for walking. Patients rated their surgical results as good or excellent in 21 feet (84%) at 1 year and in 22 feet (88%) at 7 years. Their findings include a reduction in plantar metatarsal head callous formation but a relatively high nonpurchasing toe rate of 68%.


Physical and radiographic examination of the patient can determine the underlying etiology. Metatarsalgia most often results from structural or functional abnormalities. A different combination of these underlying factors can characterize symptoms that occur during the stance phase of gait versus the propulsive phase. The Weil osteotomy was developed primarily to treat the symptomatic, dysfunctional forefoot with an unbalanced metatarsal parabola. This is characterized by an elongated metatarsal with a propulsive-type hyperkeratotic lesion. Chronic submetatarsal phalangeal joint bursitis or a secondary soft tissue contracture may be present as well.


The overall physical examination must include the evaluation of concomitant deformities such as hammertoe contractures, hallux valgus, and hypermobility of the first ray. These deformities, if present, most often need to be surgically addressed as well.

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Jul 26, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on The Weil Lesser Metatarsal Osteotomy

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