Second Metatarsal Shortening With First MTP Fusion: Is it Necessary?

by Vince Vacketta, DPM

To examine whether adding a second metatarsal shortening (Weil) osteotomy is truly needed to address transfer metatarsalgia in patients undergoing first MTPJ arthrodesis, a new study compared outcomes between patients who had first MTPJ fusions alone and those who received the fusion combined with a second metatarsal Weil osteotomy.

Study results

• A second metatarsal Weil osteotomy is not needed

• Pain and functional outcomes were similar between both groups at final follow-up

• Patients who had the additional osteotomy experienced: 

• Longer operative times 

• Higher rates of stiffness, hardware irritation, and recurrent second metatarsalgia

• Higher complication and reoperation rates

Bottom line

Adding a routine second metatarsal shortening osteotomy does not improve outcomes when combined with a first MTP fusion. Evidence supports a selective, rather than a routine, approach. 

Consider a second metatarsal osteotomy in cases of:

• Severe preoperative second MTPJ instability

• Fixed crossover toe deformity

• Significant length discrepancy