Comparative analysis of the functional results of Weil osteotomy with and without screw fixation in metatarsalgia

Introduction: Metatarsalgia is a widespread pathology of the forefoot, manifesting as pain syndrome and functional limitations. When conservative treatment is ineffective, the "gold standard" for surgical correction is the Weil osteotomy with screw fixation of the fragments. However, this method is associated with the risk of implant-related complications (such as migration, screw fracture, foreign body reaction) and requires a long period of load restriction and rehabilitation. As an alternative, the technique of performing the Weil osteotomy without internal fixation is considered, which potentially allows for reduced recovery times due to the possibility of earlier axial loading.

Objective: To compare long-term functional outcomes and the frequency of postoperative complications after the Weil osteotomy with screw fixation and without it.

Materials and methods: A retrospective cohort study was conducted, including 146 patients (297 osteotomies) who underwent surgery between 2022 and 2024. Patients were divided into two groups: Group 1 (standard technique with fixation using 2.0 mm Herbert screws, n = 89 patients, 159 osteotomies) and Group 2 (technique without implant fixation, n = 57 patients, 138 osteotomies). The mean follow-up period was 18 months. Outcomes were assessed using the validated functional AOFAS Lesser Metatarsophalangeal-Interphalangeal Scale (LMIS) and the Visual Analog Scale (VAS) for pain intensity, as well as control radiography data. All intra- and postoperative complications were recorded. Statistical analysis was performed using the Mann – Whitney U test and χ² test (significance level p < 0.05).

Results: Analysis of functional outcomes revealed no statistically significant differences between the groups: the mean AOFAS LMIS score in Group 1 was (70.8 ± 15.2), and in Group 2 it was (77.3 ± 12.7) (p = 0.11). Pain intensity on the VAS was also comparable: (3.8 ± 2.1) and (3.2 ± 1.9) points, respectively (p = 0.14). However, the analysis of complications revealed significant advantages of the fixation-free technique: the incidence of transfer metatarsalgia in Group 1 reached 31.5 %, while in Group 2 it was only 17.5 % (p = 0.04). The rate of revision interventions was twice as high in the fixation group (18.0 % vs. 8.8 %, p = 0.04). Furthermore, a statistically significant reduction in recovery time was recorded in Group 2 – (6.3 ± 1.8) weeks versus (8.2 ± 2.1) weeks in Group 1 (p < 0.01).

Conclusion: The fixation-free Weil osteotomy demonstrates long-term functional results and levels of pain syndrome comparable to the classical technique. At the same time, the fixation-free technique offers a number of significant advantages: a significantly lower incidence of transfer metatarsalgia (a 44 % reduction) and the need for revision surgeries (a 51 % reduction), as well as a 23 % shorter functional recovery period. Thus, the Weil osteotomy technique without internal fixation is a clinically feasible and promising alternative to the standard approach, allowing for minimized complication risks and accelerated return of patients to active life.