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Guo Z, Xiong B, Zhang L, Cao X, Sun X, Sun W. Advances in the Causes and Treatment of Floating Toes after the Weil Osteotomy: A Scoping Review. Orthop Surg 2024; 16:1257-1268. [PMID: 38693601 PMCID: PMC11144501 DOI: 10.1111/os.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/23/2024] [Accepted: 03/24/2024] [Indexed: 05/03/2024] Open
Abstract
The floating toe deformity is classified as a forefoot deformity wherein the distal portion of the toe does not establish touch with the ground, resulting in a suspended or elevated position while the finger is in a relaxed state. At first, it garnered considerable interest as a complication It is worth noting that this condition is particularly common in children under the age of 8, which usually disappears as the individual reaches maturity. Studies have shown that with the aggravation of floating toe deformity, its adverse effects on patients' gait and overall quality of life also increase. Despite the prevalence of floating toe deformity in clinical settings, there is a lack of comprehensive literature investigating its underlying causes and potential preventive strategies. This scope review follows the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) statement guidelines for scope reviews. The literature was obtained from various full-text databases, including China National Knowledge Infrastructure Database (CNKI), Wanfang Database, PubMed, and Web of Science Database. Our search focused on published literature related to floating toes, Weil osteotomy, and distal metatarsal osteotomy, up until March 1, 2023. The literature search and data analysis are conducted by two independent reviewers. If there are any disagreements, a third researcher will participate in the discussion and negotiate a decision. Furthermore, two experienced foot and ankle surgeons conducted a thorough literature analysis for this review. Sixty-two articles were included. Through the clinical analysis of the structural changes of the forefoot before and after operation, the classification of floating toe was described, the causes of pathological floating toe were summarized, and the possible intervention measures for the disease were put forward under the advice of foot and ankle surgery experts. We comprehensively summarize the current knowledge system about the etiology of floating toe and put forward the corresponding intervention strategy. We recommend that future studies will focus on the improvement of surgical procedures, such as the combination of Weil osteotomy, proximal interphalangeal (PIP) arthrodesis and flexor tendon arthrodesis.
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Affiliation(s)
- Ziyan Guo
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Binglang Xiong
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Longwei Zhang
- Advanced ChemistrySchool of Science Xi'an Jiaotong‐liverpool UniversitySuzhouChina
| | - Xuhan Cao
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Xudong Sun
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Weidong Sun
- Wangjing HospitalChina Academy of Chinese Medical SciencesBeijingChina
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Wako M, Koyama K, Furuya N, Shinohara R, Otawa S, Kobayashi A, Horiuchi S, Kushima M, Yamagata Z, Haro H. Relationship between floating toes condition and lower limb muscle weight in 8-year-old children: the Yamanashi adjunct study of the Japan Environment and Children's Study (JECS-Y). J Phys Ther Sci 2023; 35:252-256. [PMID: 36866014 PMCID: PMC9974319 DOI: 10.1589/jpts.35.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/14/2022] [Indexed: 03/04/2023] Open
Abstract
[Purpose] Floating toe is a condition in which the toes make insufficient contact with the ground. Weak muscle strength is reportedly one cause of floating toe. However, little evidence exists regarding the relationship between foot muscle strength and floating toe. Here we examined the relationship between foot muscle strength and floating toe by investigating the children' lower extremity muscle mass and floating toe conditions. [Participants and Methods] This cohort study enrolled 118 8-year-old children (62 females, 56 males) with recorded footprints and muscle mass evaluations using dual-energy X-ray absorptiometry. We calculated the floating toe score using the footprint. We measured the muscle weights and the muscle weights divided by the lengths of the lower limbs separately on the left and right sides using dual-energy X-ray absorptiometry. [Results] No significant correlations were observed between the floating toe score and muscle weights or muscle weights divided by lower-limb lengths for either gender or side. [Conclusion] In this study, no significant correlation was found between floating toe degree and lower limb muscle mass, suggesting that lower limb muscle strength is not the primary cause of floating toe, at least in children.
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Affiliation(s)
- Masanori Wako
- Department of Orthopedic Surgery, Faculty of Medicine,
University of Yamanashi: 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan,Corresponding author. Masanori Wako (E-mail: )
| | - Kensuke Koyama
- Department of Orthopedic Surgery, Faculty of Medicine,
University of Yamanashi: 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan
| | - Naoto Furuya
- Department of Orthopedic Surgery, Faculty of Medicine,
University of Yamanashi: 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Anna Kobayashi
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, Interdisciplinary Graduate
School of medicine, University of Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopedic Surgery, Faculty of Medicine,
University of Yamanashi: 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan
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Wako M, Fujimaki T, Koyama K, Furuya N, Shinohara R, Otawa S, Kobayashi A, Horiuchi S, Kushima M, Yamagata Z, Haro H. A cross-sectional study on the correlations between floating toe, plantar arch posture, and body composition in 8-year-old children. Foot Ankle Surg 2022; 28:1035-1039. [PMID: 35210187 DOI: 10.1016/j.fas.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/01/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Floating toe (FT): inadequately in contact with the ground and flexible flat foot (FFF) are frequently seen in children. According to some reports, inadequate foot muscle strength may cause FT or FFF.Therefore, a relationship may exist between arch formation, FT, and pedal muscle strength. This study aimed to evaluate the correlation of FT with plantar arch posture and body composition, including overall muscle mass. METHODS We conducted our own cohort study in addition to the Japan Environment and Children's Study conducted by the Ministry of the Environment, Japan. Out of 705 eight-year-old children participating in this adjunct study, 578 with recorded footprints were included. Body composition (body weight, body fat percentage, and predicted muscle mass) was assessed using body composition analyzer. Presence of FT or FFF was evaluated using foot pressure plate. We calculated the FT score (small FT score indicates insufficient ground contact of the toes) and the Chippaux-Smirak Index (CSI) using images of the plantar footprint. RESULTS The FT score (an indicator of FT) showed no significant correlation with CSI (an indicator of plantar arch posture). Moreover, no significant correlations between the predicted muscle mass, FT score, and CSI were observed. CONCLUSIONS This is the first report that assessed the relationship of FT with plantar arch posture and body composition in children. This study indicated that muscle strength might not be a major factor for FT and FFF development in children.
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Affiliation(s)
- Masanori Wako
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan.
| | - Taro Fujimaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Kensuke Koyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Naoto Furuya
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Anna Kobayashi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
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Bougiouklis D, Tyllianakis M, Deligianni D, Panagiotopoulos E. Comparison of the Weil and Triple Weil Osteotomies: A Clinical Retrospective Study. Cureus 2022; 14:e22220. [PMID: 35340462 PMCID: PMC8927858 DOI: 10.7759/cureus.22220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: The Weil and triple Weil osteotomies are two widely used procedures in the surgical treatment of metatarsalgia. The aim of this comparative retrospective study was to evaluate the functional results and determine the complications of the two types of osteotomies in a series of patients who underwent surgery due to third rocker metatarsalgia. Material and methods: In this paper, 71 patients were included between September 2015 and October 2020. The average age was 58 years old (age range: 28-72). Of all the patients, 27 suffered from metatarsalgia due to systemic (extra-regional) or regional diseases were excluded. The remaining 44 patients, after six months of unsuccessful conservative treatment, underwent surgery. Based on the preoperative planning to restore the peripheral parabolic curve of the metatarsals, when a shortening of less than or equal to 3 mm was required, a Weil osteotomy was performed. However, when a shortening of more than 3 mm was required, a triple Weil osteotomy was performed. Therefore, two groups of patients were formed, and a total of 90 osteotomies were performed. During the postoperative period, all the patients were clinically and radiographically assessed. The American Orthopedic Foot and Ankle Society (AOFAS) score was used for the assessment of the functional result, while the pain was assessed using the Visual Analogue Scale (VAS). Results: The mean follow-up was 24 months. The average operative time for the Weil and the triple Weil osteotomies was 22.8 minutes and 31.5 minutes, respectively. In group A, preoperatively, the average AOFAS score was 31/100, and postoperatively, it was 89/100. In group B, the corresponding values were 30/100 and 93/100, respectively. In group A, the preoperative VAS score was 7.8/10, while the postoperative VAS score was 1.3/10. In group B, the corresponding values were 8.2/10 and 1.7/10, respectively. In group A, stiffness had a percentage equal to 60.9%, and a floating toe was noticed in 16 osteotomies. In group B, superficial infection represented the commonest complication, with an incidence of 25.6%. Conclusion: Both Weil and triple Weil osteotomies are effective procedures in the surgical treatment of patients who suffer from third-rocker metatarsalgia. In both cases, correct preoperative planning is of paramount importance for the outcome. However, in terms of the appearance of the floating toe, it seems that in cases where a ray’s shortening of more than 3 mm is required, the triple osteotomy is superior to the Weil osteotomy.
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Bougiouklis D, Tyllianakis M, Deligianni D, Panagiotopoulos E. Biomechanical Analysis of the Change of the Metatarsophalangeal Joint’s Center of Rotation After Weil and Triple Weil Osteotomies: A Comparative Cadaveric Study. Cureus 2022; 14:e21866. [PMID: 35265408 PMCID: PMC8897981 DOI: 10.7759/cureus.21866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/07/2022] Open
Abstract
Background The aim of the present biomechanical study on cadavers was to determine both the center of rotation of the metatarsophalangeal joints and the position of the tendons of the interosseous muscles after the Weil and triple Weil osteotomies, and to compare these parameters in order to clarify the pathogenesis of dorsal stiffness and floating toe. Materials and methods Seven fresh-frozen cadaveric feet were utilized. After completing the preparation of both the plantar and the dorsal surface, we performed the dissection of the entire second, third and fourth rays, and each ray was fixed to a wooden wall mounted on a movable frame. The biomechanical analysis was based on an equilibrium system made of pulleys, threads, and variable weights. Geometrical analysis of both osteotomies and fluoroscopy was used to determine the initial and final metatarsophalangeal joint’s center of rotation, as well as the change of interosseous muscles position. Results On comparing the results of the findings, we noticed that after Weil osteotomy, the metatarsophalangeal joint’s center of rotation was proximally and plantarly displaced by 3.5 mm compared to the control group, and by 3.7 mm in comparison to the triple Weil osteotomy group. In the latter, the center of rotation was displaced by 0.817 mm compared to the control group. Furthermore, after the Weil osteotomy, the position of the interossei tendon was above the metatarsal longitudinal axis. Conclusion In cases where a metatarsal shortening of 5 mm or greater is desired, the Weil osteotomy causes a statistically significant plantar displacement of the metatarsophalangeal joint’s center of rotation, compared to cases where triple Weil osteotomy is performed.
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Chopra V, Savage T, Kruse D, Stone P. Sagittal Chevron Shortening Osteotomy With Lateral Wedge for Treatment of Lesser Metatarsal Overload: A Case Report. J Foot Ankle Surg 2021; 60:374-377. [PMID: 33422444 DOI: 10.1053/j.jfas.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Indexed: 02/03/2023]
Abstract
Metatarsalgia is a common problem that refers to the tenderness and pain beneath the forefoot. Many metatarsal shortening osteotomies have been described to alleviate metatarsal overload; however, these osteotomies have been associated with a high complication rate of floating toe deformity. We present a case study that describes an innovative technique for the treatment of lesser metatarsalgia that allows for the repositioning of the metatarsal head, using a stable screw fixation designed to minimize the common complication of the floating toe.
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Affiliation(s)
- Varun Chopra
- Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - Thomas Savage
- Attending, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - Dustin Kruse
- Director of Research, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - Paul Stone
- Program Director, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO.
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Fujimaki T, Wako M, Koyama K, Furuya N, Shinohara R, Otawa S, Kobayashi A, Horiuchi S, Kushima M, Yamagata Z, Haro H. Prevalence of floating toe and its relationship with static postural stability in children: The Yamanashi adjunct study of the Japan Environment and Children's Study (JECS-Y). PLoS One 2021; 16:e0246010. [PMID: 33760833 PMCID: PMC7990192 DOI: 10.1371/journal.pone.0246010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
Floating toe (FT) is a frequently seen condition in which a toe is inadequately in contact with the ground. Although toes play an important role in stabilizing standing posture and walking, many aspects of the effects of FT on the body remain unclear. To our knowledge, there have been no reports about the relationship between FT and postural stability, especially in children. This study aimed to clarify the prevalence of FT and its relationship with static postural stability in children. Of the 400 children aged 8 years who participated in our cohort study, 396, who were examined for static postural stability, were included in this study. Postural stability and FT were assessed using a foot pressure plate. The sway path length of the center of pressure and the area of the ellipse defined as the size of the area marked by the center of pressure, were measured as an evaluation of static postural stability. We calculated the "floating toe score (FT score: small FT score indicates insufficient ground contact of the toes)" using the image of the plantar footprint obtained at the postural stability measurement. The rate of FT was elevated at more than 90%, and the FT score in the eyes-closed condition was significantly higher than that in the eyes-open condition in both sexes. The FT score significantly correlated with the center of pressure path and area. Our results suggest that ground contact of the toes is not directly related to static postural stability in children, but it may function to stabilize the body when the condition becomes unstable, such as when the eyes are closed.
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Affiliation(s)
- Taro Fujimaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Masanori Wako
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
- * E-mail:
| | - Kensuke Koyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Naoto Furuya
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Anna Kobayashi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan
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Yanagiya T, Hata K, Takeshita T, Noro H, Yoshida T, Koyama M, Miyamoto A. Athletic event-specific characteristics in floating toes during the static standing posture. J Phys Ther Sci 2020; 32:342-347. [PMID: 32425352 PMCID: PMC7192739 DOI: 10.1589/jpts.32.342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/25/2020] [Indexed: 11/26/2022] Open
Abstract
[Purpose] We aimed to determine the cause of floating toe syndrome, along with methods
for correction and prevention. [Participants and Methods] We recruited 93 Japanese male
students. Participants were grouped, according to primary sport, as Sprinters (SPR),
Swimmers (SWM), Gymnasts (GYM), Kendoists (KND) and Controls (CON). Degree of floating toe
syndrome was measured according to whether any toe was not in full contact with the ground
in a static standing posture—the Floating Toe Point (FTP). Two points were given for each
toe that was not at the FTP. The sum of the FTP was defined as the Floating Toes Score
(FTS), and was classified as follows: Normalcy (over 18 points), Incomplete Contact
(between 10 and 17 points), and Floating Toes (Under 9 points). [Results] The mean FTS for
all participants (10.40 ± 5.803) met the criteria for Floating Toes. Scores were highest
for SWMs (13.46 ± 5.710), followed by GYMs (13.26 ± 4.505), and SPRs (12.00 ± 4.870), who
all met the criteria for Incomplete Contact. Both KNDs (6.55 ± 5.409) and CONs (9.45 ±
4.824) met the criteria for Floating Toes. [Conclusion] SWMs had the highest FTSs,
followed by GYMs, and SPRs. KNDs had the lowest FTS. However, no group was classified as
Normal. We suggest that athletes who practice or train with bare feet do not necessarily
have higher FTSs, if evaluated in the standing posture.
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Affiliation(s)
- Toshio Yanagiya
- Graduate School of Health and Sports Science, Juntendo University: 1-1 Hiaraga-gakuendai, Inzai City, Chiba 270-1695, Japan
- Institute of Health and Sports Science & Medicine, Juntendo University, Japan
| | - Keiichiro Hata
- Graduate School of Health and Sports Science, Juntendo University: 1-1 Hiaraga-gakuendai, Inzai City, Chiba 270-1695, Japan
| | - Tomonari Takeshita
- Graduate School of Health and Sports Science, Juntendo University: 1-1 Hiaraga-gakuendai, Inzai City, Chiba 270-1695, Japan
- Institute of Health and Sports Science & Medicine, Juntendo University, Japan
| | - Hiroaki Noro
- Graduate School of Health and Sports Science, Juntendo University: 1-1 Hiaraga-gakuendai, Inzai City, Chiba 270-1695, Japan
| | - Taira Yoshida
- Graduate School of Health and Sports Science, Juntendo University: 1-1 Hiaraga-gakuendai, Inzai City, Chiba 270-1695, Japan
- Gifu Sports Science Center, Japan
| | - Motoki Koyama
- Graduate School of Health and Sports Science, Juntendo University: 1-1 Hiaraga-gakuendai, Inzai City, Chiba 270-1695, Japan
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Abstract
Weil osteotomy (WO) is the most common technique worldwide for the treatment of mechanical metatarsalgia. The main indication for WO is propulsive/third rocker metatarsalgia that is in relation with an abnormal length of a certain metatarsal with respect to the neighboring metatarsals in the frontal plane. Most clinical studies have showed good to excellent results after WO. However, complications such as floating toes led to evolution of WO and the development of the triple-cut WO that allows for shortening coaxial to the shaft without plantar translation of metatarsal head. Other variations of WO may treat other forefoot disorders.
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Affiliation(s)
- Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Madrid, Spain.
| | - Ernesto Maceira
- Orthopaedica Foot and Ankle Unit, Complejo Hospitalario La Mancha Centro, Av de la Constitución 3, 13600, Alcázar de San Juan, Ciudad Real, Spain
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Abstract
The anatomy of the lesser toes is highly complicated and not yet well understood. The high propensity of the metatarsophalangeal joint to develop hyperextension deformity should be recognized. Surgeons should provide each patient with a realistic expectation for lesser toe reconstructive procedures. A successful surgical result requires a well-planned procedure, accurate execution using proper techniques, and meticulous postoperative care. When complications occur, surgeons should identify culprits so that proper treatment strategies can be successfully executed. This article discusses a wide array of tactics to manage common complications in lesser toe surgery.
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Pascual Huerta J, Arcas Lorente C, García Carmona FJ. La osteotomía de Weil: una revisión comprensiva. REVISTA ESPAÑOLA DE PODOLOGÍA 2017. [DOI: 10.1016/j.repod.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Flint WW, Macias DM, Jastifer JR, Doty JF, Hirose CB, Coughlin MJ. Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability. Foot Ankle Int 2017; 38:234-242. [PMID: 27852647 DOI: 10.1177/1071100716679110] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lesser metatarsophalangeal (MTP) joint instability is a common cause of forefoot pain. Advances in operative technique and instrumentation have made it possible to anatomically treat plantar plate tears through a dorsal approach. Our goal was to evaluate the subjective, functional, and radiographic outcomes of plantar plate repair (PPR) from a dorsal approach. METHODS A prospective case series was performed evaluating the results of PPR in 97 feet with 138 plantar plate tears. Patients underwent PPR from a dorsal approach with a Weil osteotomy. We followed patients at regular intervals for 12 months and collected data preoperatively and postoperatively with respect to visual analog scale (VAS) scores, MTP range of motion (ROM), paper pull-out test, American Orthopaedic Foot & Ankle Society (AOFAS) scores, satisfaction, and radiographic measures. RESULTS Eighty percent of patients scored "good" to "excellent" satisfaction scores at 12 months. The mean VAS pain score preoperatively was 5.4/10, and postoperatively was 1.5/10. The mean AOFAS scores increased from 49 to 81 points following surgery. The mean MTP ROM preoperatively was 43 degrees and postoperatively 31 degrees. Forty-two percent of toes passed the paper pull out test prior to surgery and 54% at 12 months. Mean metatarsal shortening was 2.4/3.1/1.2 mm for the second, third, and fourth metatarsals, respectively. The mean MTP joint angles preoperatively were 2/4.9/-1.3 degrees and postoperatively were 7.4/9.6/0.2 degrees, respectively, for the second, third, and fourth MTP joints. CONCLUSION We found that the plantar plate could be repaired through a dorsal approach with reliable outcomes. PPR was a viable option to anatomically restore the ligamentous support in the unstable lesser MTP joint. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Wesley W Flint
- 1 Orthopaedic Institute of Henderson, Henderson, NV, USA
| | | | | | - Jesse F Doty
- 4 University of Tennessee Erlanger Foot and Ankle Institute, Chattanooga, TN, USA
| | - Christopher B Hirose
- 5 Coughlin Foot and Ankle Clinic, Saint Alphonsus Regional Medical Center, Boise, ID, USA
| | - Michael J Coughlin
- 5 Coughlin Foot and Ankle Clinic, Saint Alphonsus Regional Medical Center, Boise, ID, USA
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Tasaka S, Matsubara K, Nishiguchi S, Fukutani N, Tashiro Y, Shirooka H, Nozaki Y, Hirata H, Yamaguchi M, Matsushita T, Fukumoto T, Aoyama T. Association between floating toe and toe grip strength in school age children: a cross-sectional study. J Phys Ther Sci 2016; 28:2322-5. [PMID: 27630423 PMCID: PMC5011587 DOI: 10.1589/jpts.28.2322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/14/2016] [Indexed: 11/25/2022] Open
Abstract
[Purpose] This study investigated the association between floating toe and toe grip
strength. [Subjects and Methods] A total of 635 Japanese children aged 9–11 years
participated in this study. Floating toe was evaluated using footprint images, while toe
grip strength was measured using a toe grip dynamometer. All 1,270 feet were classified
into a floating toe group and a normal toe group according to visual evaluation of the
footprint images. Intergroup differences in toe grip strength were analyzed using the
unpaired t-test and logistic regression analysis adjusted for age, gender, and Rohrer
Index. [Results] There were 512 feet (40.3%) in the floating toe group. Mean toe grip
strength of the feet with floating toe was significantly lower than that of normal feet
(floating toe group, 12.9 ± 3.7 kg; normal toe group, 13.6 ± 4.1 kg). In addition, lower
toe grip strength was associated with floating toe on logistic regression analysis after
adjustment for age, gender, and Rohrer Index (odds ratio, 0.954; 95% confidence interval,
0.925–0.984). [Conclusion] This study revealed that lower toe grip strength was
significantly associated with floating toe. Therefore, increasing toe grip strength may
play a role in preventing floating toe in school age children.
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Affiliation(s)
- Seishiro Tasaka
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Keisuke Matsubara
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Shu Nishiguchi
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Japan
| | - Naoto Fukutani
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Yuto Tashiro
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Hidehiko Shirooka
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Yuma Nozaki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Hinako Hirata
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Moe Yamaguchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Tomofumi Matsushita
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Takahiko Fukumoto
- Department of Physical Therapy, Faculty of Health Science, Kio University, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
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15
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Complicaciones de la osteotomía de Weil: análisis retrospectivo de 25 pies intervenidos en 21 pacientes. REVISTA ESPAÑOLA DE PODOLOGÍA 2016. [DOI: 10.1016/j.repod.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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Aydogan U, Moore B, Andrews SH, Roush EP, Kunselman AR, Lewis GS. Comparison of Proximal and Distal Oblique Second Metatarsal Osteotomies with Varying Achilles Tendon Tension: Biomechanical Study in a Cadaver Model. J Bone Joint Surg Am 2015; 97:1945-51. [PMID: 26631995 PMCID: PMC4657221 DOI: 10.2106/jbjs.o.00216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal surgery for reducing pressure under the second metatarsal head to treat metatarsalgia is unknown. We tested our hypothesis that a proximal oblique dorsiflexion osteotomy of the second metatarsal would decrease second-metatarsal plantar pressures in a cadaver model with varying Achilles tendon tension. We also tested the plantar pressure effects of two popular techniques of distal oblique osteotomy. METHODS Twelve fresh-frozen feet from six cadavers were randomly assigned to either the distal osteotomy group (a classic distal oblique osteotomy followed by a modified distal oblique osteotomy) or proximal metatarsal osteotomy group. Each specimen was tested intact and then after the osteotomy or osteotomies. The feet were loaded with 0, 300, and 600 N of Achilles tendon tension and a 400-N ground reaction force. Plantar pressures were measured by a pressure sensitive mat and analyzed in sections located under each metatarsal. RESULTS The proximal metatarsal osteotomy significantly reduced average pressures beneath the second metatarsal head during both 300 and 600 N of Achilles tendon loading by an average of 19.4 and 29.7 kPa, respectively (p < 0.05). The modified distal oblique osteotomy significantly decreased these pressures during 600 N of Achilles tendon loading, by a mean of 20.2 kPa, which was to a lesser extent than the proximal metatarsal osteotomy. Interestingly, the classic distal oblique osteotomy was not found to have significant effects on pressures beneath the second metatarsal head. CONCLUSIONS The proximal oblique dorsiflexion metatarsal osteotomy may be the most effective procedure for decreasing plantar pressures under the second metatarsal. The modified distal oblique osteotomy may be the second most effective. CLINICAL RELEVANCE The findings of this biomechanical study help shed light on which of the common second metatarsal osteotomies are best for decreasing plantar pressures.
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Affiliation(s)
- Umur Aydogan
- Penn State Hershey Bone and Joint Institute, 30 Hope Drive, Hershey, PA 17033. E-mail address for U. Aydogan:
| | - Blake Moore
- Penn State Hershey Bone and Joint Institute, 30 Hope Drive, Hershey, PA 17033. E-mail address for U. Aydogan:
| | - Seth H. Andrews
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
| | - Evan P. Roush
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
| | - Allen R. Kunselman
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
| | - Gregory S. Lewis
- Department of Orthopaedics and Rehabilitation (S.H.A., E.P.R., and G.S.L.) and Department of Public Health Sciences (A.R.K.), Penn State Hershey College of Medicine, 500 University Drive, Hersey, PA 17033. E-mail address for G.S. Lewis:
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17
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Godoy-Santos AL, Diniz Fernandes T, Luzo C, Ortiz RT, Sakaki M, Weil L. Effectiveness of the dorsal thermoplastic locking orthosis to prevent floating toes in postoperative follow-up of Weil osteotomies: pilot study. Foot Ankle Spec 2014; 7:356-62. [PMID: 24793064 DOI: 10.1177/1938640014532131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Weil oblique distal metatarsal osteotomy is regularly used in the treatment of primary metatarsalgia. The most frequent complication is the floating toe, which occurs in up to 36% of postoperative follow-up. The theory of reducing the plantar flexor mechanism tension associated with the retraction of the dorsal structures during the healing process of the surgical procedure may explain this negative evolution. OBJECTIVE This study aimed at assessing the effectiveness of the Tucade dorsal thermoplastic locking orthosis in the prevention of floating toe after Weil osteotomy. METHODS In all, 30 patients with metatarsalgia diagnosis submitted to Weil osteotomy were treated in the postoperative period with the Tucade dorsal thermoplastic locking orthosis. RESULTS The floating toe was not observed in this case series. There was 1 case of superficial wound irritation at the dorsal surgical incision and 1 case that evolved with transfer metatarsalgia. Statistical analyses were performed-American Orthopaedic Foot and Ankle Society Scale for lateral toes and extension of the lateral toes-using the t test, and P < .0001 was obtained for comparison of the preoperative and postoperative periods in the population studied. CONCLUSION The Tucade dorsal thermoplastic locking orthosis during the postoperative period of Weil osteotomy proved to be effective in the prevention of floating toes. LEVEL OF EVIDENCE Therapeutic Level IV: Case Series.
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Affiliation(s)
- Alexandre Leme Godoy-Santos
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
| | - Tulio Diniz Fernandes
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
| | - Candida Luzo
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
| | - Rafael Trevisan Ortiz
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
| | - Marcos Sakaki
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
| | - Lowell Weil
- Department of Orthopedic Surgery, University of São Paulo, Sao Paulo, Brazil (ALGS, TDF, CL, RTO, MS)Weil Foot and Ankle Institute, Des Plaines, IL (LW)
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Herzog JL, Goforth WD, Stone PA, Paden MH. A modified fixation technique for a decompressional shortening osteotomy: a retrospective analysis. J Foot Ankle Surg 2014; 53:131-6. [PMID: 24556478 DOI: 10.1053/j.jfas.2013.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Indexed: 02/03/2023]
Abstract
A long metatarsal and/or metatarsophalangeal joint dislocation associated with a digital contracture is a surgical challenge. Without appropriate surgical correction, the patient will be predisposed to numerous complications, including persistent subluxation or dislocation, recurrent metatarsalgia, dorsiflexory contracture of the digit, transfer lesions, and inadequate pain relief. The results of the present surgical treatment options have varied, with the most common complication being a floating toe. The purpose of our study was to introduce a decompression, shortening, lesser metatarsal osteotomy with a modified fixation technique using a T-plate and to report our results. Additionally, we have discussed trigonometric analysis of metatarsal declination and shortening. We retrospectively reviewed the outcomes of 30 consecutive patients with 33 osteotomies who had been treated surgically for pathologic features associated with a long metatarsal and varying biomechanical abnormalities. Before surgery, all the patients had been treated conservatively for a minimum of 3 months. The surgical procedure included a dorsal to plantar V-shaped shortening osteotomy of a lesser metatarsal that was fixated with a T plate. The patients were assessed radiographically and using the American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal Scale and visual analog scale. The mean age at surgery was 53 (range 37 to 75) years, with a mean follow-up period of 9.1 (range 6 to 15.4) months. The average shortening of the metatarsal was 2.7 mm. One patient (3%) had had asymptomatic delayed union and 2 patients (6%) hypertrophic nonunion. No incidence of malunion or avascular necrosis was identified. Five cases (15.2%) of hardware failure occurred. The mean American Orthopaedic Foot and Ankle Society score was 76.7 postoperatively. The visual analog scale score had improved from 6.7 to 1.7. Of the 30 patients, 72% rated the overall surgical experience as excellent or good. In conclusion, the modified fixation technique for decompression, shortening metatarsal osteotomy using a T plate is a viable option when choosing a procedure to address a long, prominent metatarsal and/or digital contracture at the metatarsophalangeal joint and results in a low incidence of floating toe complications.
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Affiliation(s)
- Jessica L Herzog
- Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - W David Goforth
- Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
| | - Paul A Stone
- Director of Research, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO.
| | - Matthew H Paden
- Program Director, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO
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19
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Lee LC, Charlton TP, Thordarson DB. Flexor digitorum brevis transfer for floating toe prevention after Weil osteotomy: a cadaveric study. Foot Ankle Int 2013; 34:1724-8. [PMID: 23978707 DOI: 10.1177/1071100713502641] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A floating toe deformity occurs in many patients who undergo Weil osteotomies. It is likely caused by the failure of the windlass mechanism in shortening the metatarsal. For patients who require a proximal interphalangeal (PIP) joint arthroplasty or fusion in addition to a Weil osteotomy, the transfer of the flexor digitorum brevis (FDB) tendon to the PIP joint might restore the windlass mechanism and decrease the incidence of floating toes. METHODS Fourteen cadaveric foot specimens were examined to determine the effects of changing metatarsal length as well as tensioning the FDB tendon on the angle of the metatarsophalangeal (MTP) joint as a measure of a floating toe. RESULTS Shortening and lengthening the second metatarsal resulted in a significant change in MTP angle (P = .03 and .02, respectively), though there was no clear relationship found between the amount of change in metatarsal length and the change in MTP angle. Transferring the FDB to a PIP arthroplasty site plantarflexed the MTP joint and corrected floating toes; the change in angle was significant compared with the control and shortening groups (P = .0001 and .002, respectively). CONCLUSION This study supports the theory that change in length of the metatarsal, possibly via the windlass mechanism, plays a role in the pathophysiology of the floating toe deformity. Tensioning and transferring the FDB tendon into the PIP joint helped prevent the floating toe deformity in this cadaveric model. CLINICAL RELEVANCE Continued research in this subject will help to refine methods of prevention and correction of the floating toe deformity.
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Affiliation(s)
- Lydia C Lee
- University of Southern California, Los Angeles, CA, USA
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20
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Abstract
Introduction. The Weil osteotomy is commonly used for multiple forefoot pathologies yielding metatarsalgia. Despite its common use, the Weil osteotomy is associated with a high complication rate. Methods. A literature review was undertaken with predetermined criteria. To maximize the articles for review, prospective and retrospective studies were considered as well as multiple indications. Seventeen articles qualified for analysis, and study format, patient demographics, surgical indication, and complication rates were documented. The data obtained were totaled and evaluated for trends. Results. Details of 1131 Weil osteotomies are reported. The most commonly reported complication of the Weil osteotomy was floating toe, reported in 233 cases, with an overall occurrence of 36%. Recurrence was reported in 15% of the cases. Transfer metatarsalgia was reported in 7% of the cases, whereas delayed union, non-union, and malunion were collectively reported in 3% of the cases. Discussion. There is no consensus regarding utilization of the Weil osteotomy with prophylactic surgery, plantar plate repair, and adjunctive interphalangeal arthrodesis. These variables may alter complication rates and provide new avenues for research.
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Affiliation(s)
- Peter Highlander
- Barry University School of Podiatric Medicine and Surgery, Miami Shores, Florida, USA.
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