Weil Osteotomy and Toe Deformity

When lesser metatarsal Weil osteotomy is performed, we observe a significant correction of hammer or claw toe deformity. We just generally do (after Weil osteotomy) a toe manipulation and we observe that many toe deformities, which seemed to be rigid in the preoperative assessment, were in fact flexible after the longi tudinal decompression provided by the Weil osteotomy. After that, we just have to set a thin K-wire in the toe, excluding the MTP joint In moderate or severe hammertoe deformity,...

Surgical Anatomy

We studied the surgical anatomy of the distal part of the metatarsal and its relationships with the Weil osteotomy. The blood supply was studied by B. Valtin and Th. Leemrijse (Paris). In regards to the muscles, and as already noted by E. Pisani, and T. Leemrvijse, we have to remark that the 2nd metatarsal has only dorsal interosseous muscles and not plantar (Fig. 17a7). In this study we pointed out the relationships with the metatarsal plantar slope, notably with the studies of B. Valtin, Th....

Lesser Metatarsal Aplasia Congenital Brachi Metatarsal

Weil Osteotomy

We only have experience of this deformity for adult patients. This deformity may be painful not only on the corresponding short ray but also on adjacent metatarsals that have a relative excessive length. In adults, lengthening of the brachi metatarsal is not a good solution. We prefer to shorten the other rays not quite as far as the short metatarsal, but trying to get a compromise which respects the rules of a correct metatarsal relative length and metatarsal parabola. This technique will...

Taylors Bunion

Large Tailor Bunion

This interesting deformity presents some anatomical specificities we have studied. This led to a specific surgery. Fig. 37da. Some pathologies of the fifth ray. Taylor's bunion. Generalities. The taylor's position in the past increased or provided the taylor's bunion deformity. 1. The lateral part of the fifth metatarsal head is prominent, either by itself, or mainly as the top of the metatarso-phalangeal angulation. 2. In some cases, the prominence is also plantar. 3. 4. Two kinds of...

Overlapping Second

Overlapping Toe Surgery

This deformity has two main causes First, congenital, then arthritic hallux valgus which is in fact a crossunder first toe. We studied the characteristics with their consequences, leading to a specific surgery, which has to be mainly performed on the first ray and second MTP, but also, if necessary, on the whole forefoot. We observe that soft tissue procedures provide unpredictable correction of the overlapping second toe. On the contrary, the Weil medial shift osteotomy as described by J. B....

Lateral Wind Swept Toes Deformity

Hallux Valgus Osteotomy

In most cases, this deformity is combined with hallux valgus deformity as well as hammertoe. The wind-swept toes will remain even after correction of hallux valgus. Furthermore, the wind-swept toes are mostly combined with excessive length of the lesser metatarsals. To assess the necessity of performing lesser rays specific surgery, we perform a check test, passive hallux valgus correction which in main cases shows that the wind-swept devia tion remains in spite of the great toe correction. MTP...

MTP Joint Dislocation of the Lesser Rays

Metatarsophalangeal Joint Dislocation

First, we studied the main causes of dislocation, then the principles of surgical correction. The technique of correction is important We observe that the Weil osteotomy is a great improvement in the correction of the MTP dislocation but on the condition to perform a large proximal sliding of the metatarsal head. The ms point is critical to assess the amount of the metatarsal shortening. The adjacent metatarsals, as well as the whole metatarsal parabola, have to be taken into account. For...

Overcorrection

Joint Fusion With Staple Fixation

Overcorrection can be corrected by reverse scarf medial displacement . However, some drawbacks may occur M1 elevation the solution is a more horizontal cut , and metatarsal head necrosis no reliable solution at the moment . However, we didn't observe head necrosis when we performed the shortening of the five meta-tarsals, but this may be done when there is a whole forefoot deformity. Another surgical procedure to treat overcor-rection is very reliable It is a medial closing wedge osteotomy, as...

Basal Metatarsal Osteotomies

1st Mtp Fusion

Principally it is the first metatarsal osteotomy, notably the elevation osteotomy, or the varisa-tion osteotomy. For the other metatarsals, we use only the 20 memory staple in case of non union after any osteotomy. Fig. 21a. Basal osteotomies of the first metatarsal. 1. Variation osteotomy for correction of introgenic hallux varus see Fig. 14c3 . 2. Elevation osteotomy for correction of over pressure under the first metatarsal osteotomy or for pes cavus. 3. Treatment of a non union of...

Middle Phalanx Osteotomies

Claw Toe Deformity

1 We have to distinguish The distal Resection-Distal Interphalangeal DIP arthroplasty. The two procedures have the following common points 1 They are only a partial resection of the middle phalanx, performed through a medial approach and followed by a temporary K. wiring. 2 Indication excess of the toe length, once corrected the deformities of the MTP and the PIP joints. 3 The distal lever arm is shorter than for proximal phalanx or PIP surgery 1 - DIP arthroplasty indication mallet finger,...

Hallux Valgus in Spastic Foot

Wiring Toes

There are static conditions that increase or emphasize the hallux valgus deformity in spastic lower limbs Genu flexum, lateral rotation of the foot, foot valgus, forefoot supination and shortness of the posterior muscles and tendons. Nevertheless, the hallux valgus has to be treated and since we have used the scarf osteotomy, we observe a great improvement in the reliability of the correction. Fig. 26a. Hallux valgus in spastic foot - The conditions of increasing the forefoot deformities. 1, 2....

MTP Stiffness after Weil Osteotomy

Weil Osteotomy Complications

Generally, after the first cases were performed with enthusiastic results, surgeons observed some MTP stiffness, generally loss of plantar flexion, notably of the second ray. This is a second step we observed the same chronology. However we have worked to analyze the causes, and adapted specific techniques and postoperative management. Now we can write that we have virtually eliminated this complication, thanks to the respect of the pre, per and postoperative specific points. Fig. 17e2. Weil...

Consequences of Gastrocnemius Shortness

It first results in overpressure on the forefoot, isolating or increasing any forefoot disorder. There is also congruence on the midfoot and the rearfoot, similarly increasing a deformity, like varus or valgus, ankle instability, or increasing a plantar fasciitis or calcaneum spurs. These foot consequences are also well described by Di Giovanni 54 and above all by C. Kowalski, who studied the gastrocnemius shortness 32, 75 . Kowalski treats this shortness by physiotherapy. I find more reliable...

BRT Osteotomy in Iatrogenic Forefoot

Metatarsalgia The 5th Metatarsal

Iatrogenic problems require reliable solution for patients When recurrence or transfer metatarsalgia occurs, the BRT osteotomy is a good and accurate solution, furthermore it is a light surgery, not followed by pain nor edema. Fig. 18e1. BRT osteotomy and iatrogenic metatarsalgia 1. 1. Transfer metatarsalgia on the 2nd ray after scarf for hallux valgus. 2. Revision by BRT osteotomy on the 2nd and 3rd metatarsals. 3. Basal chevron osteotomy on the 3rd metatarsal Transfer metatarsalgia on the 2nd...

BRT Osteotomy in Pes Cavus

Pes Cavovarus

Initially we performed only basal elevation osteotomy in the 1st metatarsal and we observed the limits of this procedure - i.e. some transfer metatarsalgia on the 2nd and 3rd ray, or on the contrary, insufficiency of Ml elevation. However we observe the good results with this osteotomy regarding notably the correction of the rear foot varus since we can now easily perform basal osteotomy elevation in the lesser metatarsals, we can elevate the 1st metatarsal as far as necessary, and combine with...

Hallux Interphalangeus

Hallux Valgus Interphalangeus

P1 Shaft osteotomy is more unstable than for basal location. It requires strong fixation Some result of unsatisfactory fixation in our early experience. Fig. 11c3. P1 screw fixation is technical demanding. 1, 2, 3. The screw location has to be very accurate 1 . 4. The use of a K-wire guide improves the screw setting. Therefore the scarf screw may be used for P1 fixation. Fig. 11c4. Use of the special memory staple DePuy in fixation of shaft osteotomy. Generalities. 2. This memory...

Local Anatomy as Applied to the BRT Osteotomy

The proximal part of the metatarsals - The plantar edge is plantarly curved, provi ding favorable conditions for an oblique proximal and plantar cut. -The articular and intermetatarsal surfaces are located partly the dorsal part, and therefore preserved from the osteotomy cut. - The fifth metatarsal has a flattened proximal part where the osteotomy is more delicate to perform. - The first metatarsal has a particularly voluminous proximal plantar part. - The dorsal and plantar vascular arches...

Technique

Osteosynthesis Hand And Foot Surgery

Although several authors, like L. S. Weil, use a transverse incision for multiple osteotomies , we prefer performing the Weil osteotomy through longitudinal skin incisions, one incision for adjacent metatarsals. The metatarsal approach is located between the longus and the brevis extensor tendons. Osteotomy. The type of osteotomy cut depends on the number of metatarsals and the degree of shortening. A long horizontal cut to shorten the metatarsal upper part of the meta-tarsal head...

Hallux Valgus Dmaa

Metatarsal Osteotomy Hallux Valgus

Is the lateral shift sufficient to correct the deformity 1. In mild or moderate deformity the lateral shift is sufficient. 2. In advanced deformities, in spite of large lateral shift, the medial soft tissue tightening capsulorraphy is necessary. Fig. 07a4. Insufficient lateral shift results in undercorrection. 1. In this case only the foot with a large lateral shift has a good correction. 2. Secondary lateral shift for undercorrection is possible and successful. 1, 2. Excess of...

Scarf Osteotomy of the First Metatarsal

Distal Chevron Procedure Hallux Valgus

Scarf is a carpentry term, meaning a joint made by bevelling two beams to correspond. The aim is to set the two beams end-to-end in order to make a longer beam, providing a longer bearing surface. The join - or the cut - is similar to a flash of lightning, on a thunder sky. This is why it is called in France trait de Jupiter in Spain rayo de Jupiter in France Jupiter is Zeus. The name scarf was given in 1984 by Lowell Scott Weil to this first metatarsal osteotomy in regard to its cuts. However,...

Medial Soft Tissue Tightening Capsulorraphy

Plastia Capsular Hallux Valgus

First, the dorsal medial sensory nerve is isolated and positioned more laterally, an important step in the procedure Fig. 9 . Medial capsular closure is a key step in all corrective surgery for hallux valgus. The necessity of performing the capsulorraphy is exposed Fig. 10a In fact, we have to distinguish the cases - rarely encountered - where there is a mild deformity, for which the capsulorraphy is just a medial closure, from the other cases - the majority - for which the capsulorraphy is a...

The Procedures

Hallux Valgus Scarf

Scarf and Great Toe Osteotomies in the Treatment of Hallux Valgus The SCARF, first metatarsal osteotomy, is most often combined with the FIRST PHALANX P1 great toe osteotomy for hallux valgus correction. This is why these two procedures are described in the same chapter. Nevertheless, the scarf and the P1 osteotomy may also be used separately for other indications, such as hallux limitus. In fact, hallux valgus deformity correction may be divided into four chronological steps Fig. 01b we...

Hallux Valgus Before And After

Hallux Valgus Indication

Excess of Ml lowering by scarf. 1. It results in an overpressure and metatarsalgia on the 1st ray. 2. It is sometimes combined with a small overcorrection of the sesamoids. 3. 4. The solution is the BRT elevation osteotomy performed in the base of M1, it is preferable to fix this osteotomy with the 20 memory staple, combined if required with the first MTP joint release. Fig. 07c10. In a supinated forefoot or an hypermobile 1st ray, does the scarf replace the Lapidus procedure 1, 2....

Phalangeal Complex MSPC

Flexor Hallucis Longus Muscle

The MSPC lateral release is the first step of hallux valgus correction. We perform it in each case, because we have observed that, even for mild deformities, the correction may be inadequate when the MSPC release is not performed. The lateral release has two goals Fig. 02a 1. To release the sesamoids from the head of the metatarsal, so that after the head is displaced laterally it will lie in its correct position above the sesamoids, which should still be in their original position. - The...