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Higher patient satisfaction rates
5%
149/3124
Lower incidence of recurrent metatarsalgia
8%
251/3124
Fewer transfer lesions
6%
196/3124
Higher percentage of radiographic reduction and maintenance of the MTP joint reduction
12%
380/3124
Increased rate of malunion or pseudoarthrosis
68%
2121/3124
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The goal of surgery for metatarsalgia and a dislocated MTP joint is to improve pressure distribution within the forefoot following failure of nonsurgical measures including shoe modifications. The Weil procedure is an intra-articular osteotomy that achieves longitudinal decompression through shortening and allows joint reduction. In a Weil osteotomy the metatarsal (MT) is exposed and the direction of shortening in the original Weil procedure runs mostly parallel to the plantar aspect of the foot. The Weil osteotomy is fixed by means of a screw running perpendicular to the osteotomy line. The Helal osteotomy has no form of fixation and is made more proximally. The article by Trnka et al compared 30 patients receiving the 2 types of procedures and found that satisfaction rates, AOFAS scores, malunion rates, pseudoarthrosis rates, and MTP reduction rates were all better with the Weil osteotomy. The article by Coughlin is a review article on lesser toe deformities.
2.7
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