A Weil osteotomy is an operation to shorten and reposition a lesser metatarsal bone to relieve pain under the ball of the foot (metatarsalgia) or correct a dislocated toe joint.
An incision is made over the top of the foot. The metatarsal head is cut at an oblique angle and slid back (shortened) by a few millimetres. It is fixed with a small screw. This reduces the pressure on the ball of the foot. Multiple metatarsals may be treated. The operation takes 30-60 minutes.
A Weil osteotomy is recommended for persistent metatarsalgia, MTP joint dislocation, or crossover toes that have not responded to orthotics, padding, and footwear modification.
Metatarsal dome pads, custom orthotics, appropriate footwear, and corticosteroid injection.
Weight-bearing X-rays. Day-case procedure.
Relief of forefoot pain and correction of toe position in approximately 80-85% of patients.
The toe may not sit flat on the ground after surgery. This is the most common complication.
Forefoot swelling for several months.
Pain may shift to an adjacent metatarsal.
The osteotomy may fail to heal.
Symptoms may return.
Numbness in the toe.
MTP joint stiffness.
Wound infection.
Local, regional, or general anaesthesia.
Post-operative shoe for four to six weeks. Weight-bearing through the heel. Toe exercises begin immediately. Normal footwear at six to eight weeks. Full recovery three to six months.
Reviews at two weeks and six weeks with X-rays.
After a Weil osteotomy, the toe may sit slightly elevated and not touch the ground. This is usually painless and functionally acceptable, but some patients find it bothersome.