Weil osteotomy of the first metatarsal in the management of grade 1 to 3 hallux rigidus: a retrospective cohort of 113 cases with a mean follow-up of four years

Background: Hallux rigidus is a prevalent degenerative condition of the first metatarsophalangeal joint. While arthrodesis is the established surgical standard for advanced stages, it significantly alters gait kinematics. Joint-preserving procedures, such as the Weil distal oblique shortening osteotomy, offer potential alternatives for maintaining motion, yet their efficacy across different radiographic grades and their impact on load distribution remain subjects of clinical investigation.

Objective: This study evaluates the long-term clinical, functional, and radiological outcomes of the Weil first metatarsal osteotomy for the treatment of Coughlin and Shurnas Grade 1, 2, and 3 hallux rigidus.

Key Points: A retrospective analysis of 87 feet (72 patients) with a mean follow-up of 51 months demonstrated a significant increase in mean AOFAS scores from 54.2 to 92.2 (p < 0.001). Mean dorsiflexion improved by 9°, while plantar flexion remained stable. Radiological analysis showed a mean metatarsal shortening ratio of 9.6%. Postoperative transfer metatarsalgia occurred in 17.2% of cases at six months, resolving in most patients through conservative management; only 4.6% reported persistent symptoms at final follow-up. No significant correlations were found between clinical outcomes and preoperative metatarsal index, Coughlin grade, or the degree of metatarsal shortening. The subjective satisfaction rate was 95.4%, and no patients required secondary arthrodesis.

Conclusion: The Weil distal oblique osteotomy is an effective joint-preserving intervention for Grade 1 to 3 hallux rigidus. It provides significant pain relief and functional improvement with a low rate of persistent complications, regardless of the preoperative radiographic severity or metatarsal length.