Modification of the Weil/Maceira Metatarsal Osteotomy for Coronal Plane Malalignment During Crossover Toe Correction

Abstract

Background: Metatarsophalangeal joint (MPJ) instability, which often involves the second ray, may result in dorsal translation and coronal drift of the proximal phalanx, with subsequent crossover of the first and second toe. After traditionally described soft tissue and osteotomy procedures are used to treat this deformity, coronal plane malalignment may persist, but few additional surgical options have been described to address this problem. Methods: We present a retrospective series of 5 patients who underwent a supplemental technique to augment coronal plane MPJ realignment. All patients underwent preplanned concomitant procedures. Crossover angulation of the second MPJ, amount of coronal translation required, and overall first-second ray alignment were compared pre- and postoperatively. Results: Depending on the severity of refractory deformity after soft tissue release and decompressive metatarsal osteotomy, 1.5 to 4.5 mm of coronal plane metatarsal head translation was required to achieve 3 to 20 degrees of overall valgus correction at the MPJ and complete correction of the crossover toe deformity. All patients were satisfied and had good function at last follow-up, a mean of 10.2 months, although 3 patients exhibited some level of second MPJ stiffness. One patient ended up with a component of residual floating toe deformity that was considered more of an incomplete correction of dorsal MPJ subluxation rather than any technical complication of this translational osteotomy modification designed to primarily correct coronal plane malalignment. A second patient had asymptomatic angular malalignment through partial (coronal plane) malrotation of the metatarsal osteotomy before it had healed. Conclusions: We have found this technique modification to be a very effective and simple means of treating recalcitrant lesser MPJ coronal plane malalignment when traditional soft tissue and bony techniques fail to fully restore anatomic MPJ position. Level of Evidence: Level IV, retrospective case series.