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Médecine et chirurgie du pied

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Morphological impact to the fifth toe following a Weil’s osteotomy of the median metatarsal Volume 29, issue 3, Septembre 2013

Authors

Abstract

In our practice, Weil’s osteotomy of the metatarsals is the treatment of choice for metatarsalgia in connection with a deformity to the Maestro curve. The aim of this study is to investigate the behaviour of the fifth toe following this type of osteotomy.

Equipment and method

We used 42 observations, including 43 feet in 40 women and 2 men, with an average patient age of 49.7 years. The osteotomies were performed at the same time as treatment for hallux valgus and hammer toe, in particular to the second ray (second metatarsal overload syndrome). The angle of the deformity has been calculated to the five rays of the foot, as well as determining the Maestro curve on the reference x-rays taken before and after the procedure.

Results

The fifth ray was found to be deformed in 11 cases, including 6 that had a curvature of the metatarsal; the deformity was located either to the metatarsophalangeal or to the interphalangeal joints, which overlapped underneath; the average angle of the deformity was in the order of 40 degrees. Four cases required surgical correction: realignment of the fifth ray to the metatarsal and phalangeal joint or to the phalangeal joint alone. No correlation was found between the calculated angles of deformity before and after surgery.

Discussion

Deformity appears to be iatrogenic, secondary to the loss of plantar flexion in all metatarsophalangeal joints as the result of the osteotomies; these osteotomies destabilise the metatarsophalangeal joints, in particular to the fourth ray, enabling the fifth toe to pass below that of the fourth ray. The role of the curved deviation of the fifth metatarsal and tenotomy of the tendon of the long extensor muscle that is occasionally performed should be noted.

Conclusion

As the result of this study, osteotomy of the four lateral rays and not just the three medial metatarsals is now performed in the surgical treatment of metatarsalgia.