Weil Osteotomy and Hammertoe Repair

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The Weil osteotomy is an operation for pain in the front part of the foot, under the ball of the foot. We call this type of pain “metatarsalgia”. It may also be performed as part of an operation to straighten one or more of your toes. Metatarsalgia can usually be treated with simple measures such as:

Comfortable shoes

Weight loss

Insoles

Simple pain tablets

Other treatments, such as physiotherapy exercises, also help some people.

Wendy Nethery HammertoeIf these measures do not make you comfortable enough to live fairly normally, an operation could be considered. There are different operations depending on the cause of your metatarsalgia. If the main problem, or an important part of it, is that one of the metatarsals is too long relative to the others or points too far downwards, the Weil osteotomy would usually be advised. If you have a curved or hammer toe and wish to have it straightened, this can usually be done without involving the 2 Weil Osteomy Weil Osteomy 3 metatarsals. For some, the joint at the toe’s base (“metatarsophalangeal joint”) is so tight and stiff that it cannot easily be straightened. A Weil osteotomy of the metatarsal will relax the joint sufficiently to allow it to straighten and heal without excess pressure.

What does the operation involve?

A cut is made on top of the foot between the metatarsal bones. If you are having your toes straightened at the same time, the cut may extend into the toes or there may be separate cuts on the toes. The metatarso-phalangeal joint at the base of the toe is opened and freed to relax the tissues. A cut into the metatarsal bone allows it to slide back sufficiently to relax the joint and relieve the pressure under your foot. The amount it needs to slide is measured by your surgeon on X-rays taken before the operation. The bone is then fixed in its new place with 1 or 2 tiny screws and the cut is closed. This process may be performed on one or more metatarsal bones. You may need to have several bones done if:

More than one bone is painful

More than one toe is being straightened

Only one bone is painful but reshaping this bone will put pressure on the other bones of the foot. In this case, 2 or 3 bones may be reshaped to even out the pressures.

What is a hammertoe?

A hammertoe is a deformity that causes a toe to become bent upward in the middle so it resembles a hammer. Hammertoes often occur in conjunction with other toe problems. It is possible to develop corns on top of the middle joint of the hammertoe.   Patients who have hammertoes try to manage them by treating the symptoms. This involves padding the toe and changing or stretching shoewear for comfort. If you still experience discomfort from the hammertoe you may consider surgery.   The hammertoe can be flexible or stiff. Depending on the flexibility of the toe and the preference of your orthopaedic foot and ankle surgeon, several different surgeries can be used to treat the hammertoe.

What is the goal of hammertoe surgery?

The goal of surgery is to treat pain that has not gotten better with non-surgical treatment.

What signs indicate hammertoe surgery may be needed?

If you have pain or cannot comfortably wear shoes after trying non-operative treatments, hammertoe surgery may be an option.

When should I avoid hammertoe surgery?

Patients with multiple problems in addition to the hammertoe should avoid surgery for just the hammertoe alone. Additional surgery may be needed to address the other deformities as well. Other reasons to avoid hammertoe surgery include active infections, poor circulation, and any serious illness that would make surgery unsafe. You should discuss your health history with your orthopaedic surgeon prior to considering hammertoe surgery.   General Details of the Procedure Most often, hammertoe correction is done as an outpatient procedure. This means that you can go home the same day as the surgery. The surgery can either be done with you fully asleep, or it may be done with you awake after you have been given medicine that makes the foot go numb temporarily.

Specific Technique Flexible Hammertoe

If your hammertoe is flexible and your orthopaedic surgeon can straighten the toe, a tendon transfer procedure may be used to correct the problem. This involves rerouting the tendons from the bottom of the toe to the top of the toe where it is sticking up. This helps pull the bent joint into a straight position.

Fixed Hammertoe

If your hammertoe has become fixed (stiff), there are two options for treatment. Joint resection can be used to treat the fixed hammertoe. In this procedure an incision is made over the top of the toe. Ligaments and tendons may be cut to help with straightening the toe. The end of the bone is removed to allow the toe to straighten completely, and pins are temporarily used to hold the toe straight. The pins are usually removed three to four weeks after the surgery.   Fusion can also be used to treat the fixed hammertoe. In this procedure, the ligaments and tendons are cut to help straighten the toe. The ends of the bone are cut and the toe is straightened. Pins, screws or other implants can be used to keep the toe straight while the bone ends heal together.

See more at https://youtu.be/ExJ9KrMrMqA

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