Lesser Toe Surgery - Weil Osteotomy

Weil osteotomy

This operation is performed for toe clawing or metatarsalgia (pain under the ball of the foot).   It involves a metatarsal osteotomy ((bone cut and screw fixation) and lengthening/release of the tight extensor tendons and joint capsule.   This is performed through an incision of the dorsum (top) of the foot, 4-5 cm long.

The osteotomy requires protection in the post-operative shoe for 4-6 weeks. The post-operative shoe allows for heel weightbearing (walking) immediately though this is often too uncomfortable for the first week. The foot must be elevated (above the level of the pelvis) for 90% of the time for the first 10 days. This helps to reduce swelling and the risk of infection, and helps wound healing.  Naturally, short periods of walking/standing are allowed.

The surgery is routine, though the recovery is prolonged.

Risks of surgery
Stiffness & swelling
Initially the foot will be very swollen and needs elevating. The swelling will disperse over weeks/months but may still be apparent at 6-9 months.  Often shoes will remain tight for 8-12 weeks. The toe will be stiff but will usually regain its original movement.

Infection
There is always a risk of infection with surgery. You will be given 1 dose of intravenous antibiotics during surgery. The best way to reduce the chance of acquiring an infection is to keep the foot elevated for 10 days. If there is an infection it normally resolves with a course of oral antibiotics.

Nerve damage
A nerve supplying the side of the toe lies beneath the incision, and is at risk of damage.   Usually it is just bruised and will recover.  If the damage is permanent, it will leave a small patch of numbness.   This does not normally cause any disability.

Undercorrection
Occasionally, the deformity of the toe is not fully corrected. This is more common in severe cases.  This is rarely problematic and requiring further surgery.

Avascular Necrosis
This is where the blood supply to the bone is disrupted, leading to the bone tissue dying and collapsing, and the joint surfaces being damaged. This can lead to arthritis (pain and stiffness), which may require further surgery.

Incomplete relief of symptoms
The majority of symptoms will be improved by this procedure. Any remaining symptoms can be accommodated with foot orthoses.

Sick leave             
2 weeks off work for sedentary jobs
6 weeks off work for standing/walking jobs
8 weeks off work for manual / labour jobs
We will provide a sick note for the first 2 weeks; further notes can be obtained from the GP.

Post operative instructions for the ward
Elevate the leg
Check X-ray prior to discharge
Mobilise fully HEEL weight-bearing in post op shoe for 4-6 weeks
Dressings can be changed at 3-4 days.    

Follow up
2 weeks - Removal of sutures – Mr Henry Atkinson’s Foot clinic
6 weeks - Weight-bearing AP and Lateral X-rays - Mr Henry Atkinson’s Foot clinic


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