[Weil's cervicocapital osteotomy for median metatarsalgia. Report of 70 cases]. / L'ostéotomie cervico-capitale de Weil dans les métatarsalgies médianes. Etude de 70 cas.

The authors report a series of Weil's cervicocapital metatarsal osteotomies which were performed to treat central metatarsalgias. The series included 70 central metatarsalgias treated by osteotomy of one to four metatarsals. There was an excess of length of one or several metatarsals in all cases; there were 30 metatarsophalangeal dislocations. The results were evaluated according to Kitaoka's criteria: 20 were quoted very good, 26 good, 9 fair and 3 poor. The osteotomy gave an overall improvement regarding pain and shoe fitting but the mobility of the MP joint was reduced in all cases. The results were satisfactory in cavus feet and in cases where the osteotomy was combined with correction of a hallux valgus. Weil's osteotomy allows accurate adjustment of the shortening and early weight-bearing. This is indicated in cases with excessive length of the central metatarsals and also in cases with metatarsophalangeal dislocations.

Scarf osteotomy for hallux valgus correction. Local anatomy, surgical technique, and combination with other forefoot procedures.

At first, scarf osteotomy can be technically demanding. The aim of the author has been to develop an efficient technique, make it easier and more accurate, and to achieve immediate reproducibility of results. Neither the skin incision nor the length of the osteotomy result in postoperative edema, whereas the strong fixation enables very early functional recovery. Complications are rare and avoidable. The sum of the scarf's advantages results in a reliable surgical procedure. The scarf osteotomy is extremely versatile, because it allows a wide range of fragment displacement. This is why the scarf is not a single osteotomy but several. This means its indications are broad, from mild to the most advanced deformities, including arthritic, juvenile, iatrogenic, and even rheumatoid hallux valgus. The contraindications of scarf osteotomy are a very large hallux valgus deformity with a very thin first metatarsal; extremely deformed MPT joint, and hallux valgus combined with a severe pes planus and hypermobility of the first metatarsal (the Lapidus procedure is preferable at this stage). Finally, we should remember the two following points: 1. Whatever the indication, the scarf first metatarsal osteotomy is only one of the four steps necessary for correcting hallux valgus deformity: a) MTP lateral release, b) Scarf osteotomy, c) medial capsulorraphy, and d) great toe proximal osteotomy. 2. The scarf is just one element of the different procedures, including the Weil lesser ray osteotomy, which allow precise forefoot management according to each static disorder. These techniques have very significantly extended the indications for most static disorders where corrective surgery preserves the joints and their mobility.

[Weil's metatarsal osteotomy in the treatment of metatarsalgia]. / Die Metatarsalosteotomie nach Weil zur Behandlung der Metatarsalgie.

The Weil distal shortening osteotomy of the lesser metatarsals has been used by the author since June 1992, particularly in the treatment of metatarsalgia. Its advantages are a direct approach to the metatarsophalangeal (MP) joint and the metatarsal head, providing not only correction of the deformity, but accurate control of the metatarsal shortening, primary healing and early functional recovery thanks to the strong fixation allowed by the twist-off screw. Its disadvantage is the limitation of MP articular range motion, which is temporary in most cases. The role of the Weil osteotomy in metatarsalgia is to bring the metatarsal head behind the callus and to provide an axial decompression resolving the hammer toe deformity or MP luxations that are increasing or resulting in metatarsalgia. In cases of metatarsalgia resulting from the first ray insufficiency, the Weil osteotomy is a fair, reliable and efficient procedure; it is also good in cases when the small metatarsal bones are too long. However, shortening the metatarsal bones has to be part of general forefoot therapeutic management. In isolated metatarsalgia, the indication may be slightly difficult, indicating a "slimming" resection. In contrast, both in important metatarsalgia, and generally in severe forefoot disorders, the Weil osteotomy, together with the scarf osteotomy, constitutes a real surgical improvement, opening a new means of articular conservative treatment of severe static disorders.

Osteotomies of the great toe.

Patients are operated on for forefoot problems at an increasingly younger age, according to the author's experience. This has resulted in extra articular osteotomies of the first phalanx of the great toe, usually associated with other forefoot procedures. There exist several indications for these osteotomies. Among them are hallux valgus, hallux rigidus, and other forefoot disorders, such as rheumatoid diseases. Since 1984, the author has performed 2850 great toe osteotomies, allowing him to specify indications, to elaborate osteotomy procedures (varisation, derotation, shortening) and to devise appropriate implants, including specific staples and compression screws. A great toe osteotomy system has resulted in facilitating the execution of this very useful procedure.