Metatarsals and hammertoes

[jehjr]

What are people's thoughts on metatarsal osteotomies for severely contracted hammertoes on long metatarsals? Weil? Oblique sagittal? Met head resection?

I trained with people who had strong opinions all across the board. I like the idea of maintaining anatomy as much as possible, but the met head resections I see seem to do just as well.

As a resident I thought I had all the answers. Now I feel like I have more questions than ever.

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[Pronation]

TMA

 

[GreenHousePub]

I'd just fuse the hammertoes and release the MPJ. A weil then if there is a central core to the forefoot calluses. I do them this way:

https://www.researchgate.net/public...-of-modified-Weil-osteotomy-in-metatarsal.png

I don't think you are going to go wrong either way honestly. I wasn't aware of any controversial opinions regarding any of these? Is there some staunch toe guru who remains unimpressed at the current bleeding edge hammertoe concepts?

 

[jehjr]

Yes, I would do a Weil for most of these. I am meaning cases where the proximal phalanx is hanging out on top of the metatarsal neck and the met is extra long. Maintain the joint at all costs? Or just ressect the head and be done with it?

Edit: I’m being vague. I have a 40 year old female with crazy long second and third Mets. Rigid dorsally dislocated hammertoes. I could do weils, but I would probably have to pull out a wedge to shorten enough, plus there would require more dissection to reduce it enough to do the Weil. So, is it crazy to do a met head resection in a younger patient?

 

[AttackNME]

Yes, I would do a Weil for most of these. I am meaning cases where the proximal phalanx is hanging out on top of the metatarsal neck and the met is extra long. Maintain the joint at all costs? Or just ressect the head and be done with it?

Edit: I’m being vague. I have a 40 year old female with crazy long second and third Mets. Rigid dorsally dislocated hammertoes. I could do weils, but I would probably have to pull out a wedge to shorten enough, plus there would require more dissection to reduce it enough to do the Weil. So, is it crazy to do a met head resection in a younger patient?

Doesn't sound crazy esp if she has RA or severe cavus foot or something like that.

 

[air bud]

I absolutely think met head resection have a place. 40 seems young to do, but yes if RA etc then reasonable. If you truly need to shorten more than a Weil, have you ever seen the Zimmer osteotomy plate for Weil's? I have never done and think overkill for standard hammertoes. But if significant contraction then doing a hevron and floating won't do anything since not about plantar pressure and more about decompression. Same thing with standard or revised Weil, at some point can only push so much . That's where a shaft osteotomy might have a role. On a side note, have you seen that arthrex is now doing internal brace for plantar plate repair? Good way to make sure that sucker doesn't pop up. I am doing one in a few days, did recently in a lab. I think has role in a multiplamar chronic deformity.

 

[jehjr]

I’ve done the internal brace with a Weil and it’s pretty slick. I just had reps from zimmer talking about that plate recently. Not sure how I feel about it. Seems big.

Head resections sounds nice.

 

[Scrantonicity]

Kinda depends on the severity of the symptoms I think. If the met heads are causing a huge painful callus (especially with an IPK), yeah--just cut the head(s) off. Anytime I do a Weil in that case it just seems like it's not aggressive enough and they still have some pain. If it's just kinda mild and a plantar capsule (with the McGlamry) release isn't enough then I'd do the Weil.

 

[vortex341]

lol....I finally understand the saying ‘podiatrist make it seem like brain surgery’

 

[CutsWithFury]

Yes, I would do a Weil for most of these. I am meaning cases where the proximal phalanx is hanging out on top of the metatarsal neck and the met is extra long. Maintain the joint at all costs? Or just ressect the head and be done with it?

Edit: I’m being vague. I have a 40 year old female with crazy long second and third Mets. Rigid dorsally dislocated hammertoes. I could do weils, but I would probably have to pull out a wedge to shorten enough, plus there would require more dissection to reduce it enough to do the Weil. So, is it crazy to do a met head resection in a younger patient?

I do weils every single time on these dorsally dislocated rigid hammertoes in addition to PIPJ fusion +/- plantar plate repair. The shortening of metatarsal is crucial for reduction IMHO

 

[malleolusman]

Agree with above. In cases of rheumatoid foot I'll excise the met head and pin the toe if there is no other associated pathology (rarely the case) -- otherwise they get the clayton or hoffman clayton.