Of the Lesser MTP Joints Excluding Rheumatoid Lesion

First, we report our experience of the Frieberg-Koelher advanced stage treatment by Weil osteotomy, which is a reliable solution.

Then, the other types of MTP joint impairment are also reported, with samely the large and harmonized Weil osteotomy, which is the only solution for providing reliable and long-lasting result.

Fig. 32a. MTP impairment - Frieberg-Koelher and Weil osteotomy.

In advanced Frieberg-Koelher disease, a dorsal-distal edge has to be removed, as recommended by A. Gauthier (Lyon, France). However, we recommend not to remove a large edge, but to decompress the MTP joint with a combined metatarsal shortening. In this case, the first metatarsal was already too long, so that the good result showed here was obtained by the shortening of the five metatarsals.

Fig. 32a. MTP impairment - Frieberg-Koelher and Weil osteotomy.

In advanced Frieberg-Koelher disease, a dorsal-distal edge has to be removed, as recommended by A. Gauthier (Lyon, France). However, we recommend not to remove a large edge, but to decompress the MTP joint with a combined metatarsal shortening. In this case, the first metatarsal was already too long, so that the good result showed here was obtained by the shortening of the five metatarsals.

Fig. 32b1. MTP impairment (excluding rheumatoid lesion).

1. Surgery without Weil osteotomy usually does not provide good result.

2. The Weil osteotomy with small proximal sliding is usually not sufficient.

Fig. 32b1. MTP impairment (excluding rheumatoid lesion).

1. Surgery without Weil osteotomy usually does not provide good result.

2. The Weil osteotomy with small proximal sliding is usually not sufficient.

Weil Osteotomy

Fig. 32b2. MTP impairment (excluding rheumatoid lesion) - Single Weil osteotomy in a very long corresponding metatarsal.

Same case in all figures of this plate.

1, 5. This excessive length has to be assessed both on the dorso-plantar and the medial oblique X-rays views.

2, 3. Operative views.

2. The metatarsal head with its impaired cartilage.

3. Weil osteotomy. Resulting MTP longitudinal decompression.

4. 5, 6. One year follow-up: Good result, in spite of Ml remaining sligthly too long, but preserving a correct length relationship between M2 and M3.

Fig. 32b2. MTP impairment (excluding rheumatoid lesion) - Single Weil osteotomy in a very long corresponding metatarsal.

Same case in all figures of this plate.

1, 5. This excessive length has to be assessed both on the dorso-plantar and the medial oblique X-rays views.

2, 3. Operative views.

2. The metatarsal head with its impaired cartilage.

3. Weil osteotomy. Resulting MTP longitudinal decompression.

4. 5, 6. One year follow-up: Good result, in spite of Ml remaining sligthly too long, but preserving a correct length relationship between M2 and M3.

Fig. 32b3. MTP impairment (excluding rheumatoid lesion) - Necessity of large proximal sliding by Weil osteotomy.

1. Weil on the second and third metatarsals.

2. Weil on the second, third and fourth metatarsals.

3. 4. Severe impairment: Shortening of the five metatarsals: Excellent radiologic and clinical results, two years follow-up.

5, 6, 7. Another similar case, one year follow-up.

The large metatarsal shortening is certainly the best way to treat such lesions.

Fig. 32b3. MTP impairment (excluding rheumatoid lesion) - Necessity of large proximal sliding by Weil osteotomy.

1. Weil on the second and third metatarsals.

2. Weil on the second, third and fourth metatarsals.

3. 4. Severe impairment: Shortening of the five metatarsals: Excellent radiologic and clinical results, two years follow-up.

5, 6, 7. Another similar case, one year follow-up.

The large metatarsal shortening is certainly the best way to treat such lesions.

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