Abstract
Introduction: The transverse metatarsal arch is the subject of some controversy as there isn’t a clear consensus as to whether there is a transverse arch (TMA) in stance phase. The current treatment options of forefoot pathology focus on the need to harmonise the TMA by the use of osteotomies such as the Weil’s.
Materials and Methods: A retrospective study of 75 feet (62 patients) with mean follow up of 19 months. Patients underwent clinical, pedobarographic and radiological assessment. ‘Metatarsal skyline Views’ (MSV) were procured to assess the plantar profile of the TMA following Weil osteotomy. The feet were assessed using AOFAS, Foot Function Index, SF-36 and Manchester-Oxford Foot Questionnaires.
Results: 69 feet showed good to excellent results with a normal MSV plantar profile. 6 feet had recurrent metatarsalgia with callosities and abnormal MSV profiles. These results correlated well with pedobarography.
Discussion: The angle of Weil osteotomy is usually referenced relative to the floor irrespective of the plantar angulation of metatarsal. As different metatarsals had varying plantar angulations, the weight bearing metatarsal skyline view was used to ascertain the plantar profile of the metatarsals before, during and after surgery. This was also used to determine the amount of dorsal displacement required in addition to shortening in order to harmonise both length and plantar profile.
Conclusion: The use of the Metatarsal skyline view has significantly improved our planning of the angles of the Weil osteotomy. We suggest that the reference for the osteotomy should be the plantar angulation of the metatarsal rather than the floor. It has made the intraoperative assessment of the osteotomy easier and has improved our understanding of the osteotomy and its influence on the forefoot plantar profile.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
