Comparing Clinical Efficacy between Minimally Invasive Osteotomy and Weil Osteotomy for Treatment of Metatarsalgia
Zixing Bai, Xuhan Cao, Yanjun Yang, Chengyi Sun, Si Chen, Haiwei Hu, Jianmin Wen, Xinxiao Lin, Weidong Sun
Citation Information :
Bai Z, Cao X, Yang Y, Sun C, Chen S, Hu H, Wen J, Lin X, Sun W. Comparing Clinical Efficacy between Minimally Invasive Osteotomy and Weil Osteotomy for Treatment of Metatarsalgia. J Foot Ankle Surg Asia-Pacific 2022; 9 (3):142-146.
Background: Both minimally invasive osteotomy and Weil osteotomy can effectively relieve pain symptoms of metatarsal pain, but their indications and clinical efficacy lack data support.
Aim and objective: To investigate the differences of indications and clinical efficacy between the minimally invasive osteotomy and the Weil osteotomy for treatment of the metatarsalgia.
Materials and methods: One hundred and four metatarsal bones in 64 feet of 51 patients with mild metatarsalgia were divided into two groups. The minimally invasive osteotomy and elevation of metatarsal operation were performed on the 24 patients in group I, a total of 55 metatarsal bones of 26 feet. The Weil osteotomies were performed on the 27 patients in group II, a total of 49 metatarsal bones of 38 feet. The visual analog scale/score (VAS), the American College of Foot and Ankle Surgeons (ACFAS), the maximum plantar force, the peak pressure, and the force-time integrals of the target metatarsals were compared between preoperation and postoperation, respectively.
Results: All test data, such as the VAS, the ACFAS, the maximum plantar force, the peak pressure, and the force-time integrals under the target metatarsal heads after osteotomy, were significantly different (p < 0.05) from those before osteotomy in both groups. However, all the above data were not significantly different between the two groups (p > 0.05). Four metatarsals were reported to have a delayed bone healing after the minimally invasive osteotomy.
Conclusion: Both osteotomies can effectively release the pain. The minimally invasive osteotomy is easy to handle and has the advantages such as less complication, low cost, and a low requirement on equipment, which can be suggested to be widely used in the basic level hospital.
Charen DA, Markowitz JS, Cheung ZB, et al. Overview of metatarsalgia. Orthopedics 2019;42(1):e138–e143. DOI: 10.3928/01477447-20181206-06.
Maceira E, Monteagudo M. Mechanical basis of metatarsalgia. Foot Ankle Clin 2019;24(4):571–584. DOI: 10.1016/j.fcl.2019.08.008
Gu W, Shi Z, Chai Y. New progress in treatment of metatarsalgia. Int J Orthop 2009;30(3):179–180.
Wen J, Sun W, Sang Z, et al. Treatment strategies on pain caused by the corpus callosum under the metatarsal heads. Chin J Tradit Med Traumatol Orthop 2012;20(8):81–82.
Wen J, Han J, Sun W, et al. Treatment of metatarsalgia via internal fixation using absorbable screws. Orthop J China 2015;23(1):17–21.
Besse J. Metatarsalgia. Orthop Traumatol Surg Res, 2017;103(1S):S29–S39. DOI: 10.1016/j.otsr.2016.06.020
Monteagudo M, Maceira E. Evolution of the weil osteotomy: the triple osteotomy. Foot Ankle Clin 2019;24(4):599–614. DOI: 10.1016/j.fcl.2019.08.009
Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. J Am Acad Orthop Surg 2010;18(8):474–485. DOI: 10.5435/00124635-201008000-00004
Fleischer AE, Klein EE, Bowen M, et al. Comparison of combination weil metatarsal osteotomy and direct plantar plate repair versus weil metatarsal osteotomy alone for forefoot metatarsalgia. J Foot Ankle Surg 2020;59(2):303–306. DOI: 10.1053/j.jfas.2019.08.023
Khurana A, Kadamabande S, James S, et al. Weil osteotomy: assessment of medium term results and predictive factors in recurrent metatarsalgia. Foot Ankle Surg 2011;17(3):150–7. DOI: 10.1016/j.fas.2010.04.003
Sun W, Wen J, Lin X, et al. Analysis of clinical effects of two different surgical methods on metatarsalgia. Orthop J China 2016;24(21): 1997–1999.
Wong TC, Kong SW. Minimally invasive distal metatarsal osteotomy in the treatment of primary metatarsalgia. J Orthop Trauma Rehabil 2013;17(1):17–21. DOI: 10.1016/j.jotr.2012.04.004
Huang T-G, Zhang S-M, Yu G-R. Weil osteotomy. Orthop J China 2013;21(7):675–679.
Xue J-F, Shi Z-M, Dong Y, et al. Weil osteotomy for refer metatarsalgia in hallux valgus. Orthop J China 2008;1(9):653–656.
Henry J, Besse JL, Fessy MH, et al. Distal osteotomy of the lateral metatarsals: a series of 72 cases comparing the Weil osteotomy and the DMMO percutaneous osteotomy. Orthop Traumatol Surg Res 2011;97(6 Suppl):S57–65. DOI: 10.1016/j.otsr.2011.07.003
Yeo NEM, Loh B, Chen JY, et al. Comparison of early outcome of Weil osteotomy and distal metatarsal mini-invasive osteotomy for lesser toe metatarsalgia. J Orthop Surg (Hong Kong) 2016;24(3):350–353. DOI: 10.1177/1602400315
Weil Jr L, Weil Sr LS. Osteotomies for bunionette deformity. Foot Ankle Clin 2011;16(4):689–712. DOI: 10.1016/j.fcl.2011.08.012
Gregg J, Silberstein M, Clark C, et al. Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability. Foot Ankle Surg 2007;13(3):116–121. DOI: 10.1016/j.fas.2007.01.001
Redfern D. Treatment of metatarsalgia with distal osteotomies. Foot Ankle Clin 2012;23(1):21–33. DOI: 10.1016/j.fcl.2017.09.004
Rivero-Santana A, Perestelo-Pérez L, Garcés G, et al. Clinical effectiveness and safety of Weil's osteotomy and distal metatarsal mini-invasive osteotomy (DMMO) in the treatment of metatarsalgia: a systematic review. Foot Ankle Surg 2019;25(5):565–570. DOI: 10.1016/j.fas.2018.06.004
Miranda I, Al Rajab A, Al, Rajab F, et al. Osteotomáas distales de los metatarsianos menores realizadas por cirugáa ab-ierta vs cirugáa percutínea en el tratamiento de las metatarsalgias. Rev Esp Cir Osteoartic 2015;50:108–113.