Helal and Weil osteotomy in the treatment of metatarsalgia in the conditions of the transverse deformity forefoot


  • Dmytro Prozorovskiy
  • Ruslan Buznytskiy




Metatarsalgia, forefoot deformity, Helal osteotomy, Weil osteotomy


Transverse-spread deformity of the forefoot with hallux valgus is found in 75 % of women in the population. At the same time, structural and functional changes in the foot lead to redistribution of load during walking between the heads of the metatarsal bones and the occurrence of metatarsalgia. Objective. To conduct a comparative analysis of the results of surgical treatment of metatarsalgia in patients with transverse-spread deformity of the forefoot after performing corrective osteotomies Helal and Weil. Methods. The study is based on the surgical treatment of 42 (64 feet) patients with metatarsalgia due to transverse deformity of the forefoot. Patients were divided into two groups depending on the surgical method of eliminating metatarsalgia: in the first performed an osteotomy Helal (32 cases), in the se­cond — Weil (32). The mean follow-up of patients in the first group was 19.8 months, the second — 21.5 months. Results. According to the assessment of AOFAS scale, the result of treatment of metatarsalgia and transverse deformity of the forefoot in patients of the first group was 89.4 points, the second — 83.1 points. Regression of metatarsalgia in patients of the first group was recorded in 29 (90.6 %) cases, the second — in 26 (81.3 %) (criterion χ2 = 1.16; p = 0.28). Recurrences of metatarsalgia were observed in patients after the use of both Helal and Weil osteotomies and accounted for 6.3 and 9.4 % of cases, respectively. The occurrence of transfer metatarsalgia of the anterior foot was registered in 3.1 % of cases after Helal osteotomy, in 9.4 % — Weil osteotomy. Conclusions. Surgical treatment of metatarsalgia caused by transverse deformity of the forefoot with the use of corrective osteotomies Helal and Weil allowed to achieve positive results in 90.6 and 81.3 % of cases, respectively. These surgical techniques can be successfully used for the treatment of metatarsalgia of the forefoot with a violation of the metatarsal parabola.

Author Biographies

Dmytro Prozorovskiy

Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

PhD in Traumatology and Orthopaedics

Ruslan Buznytskiy

Kharkiv Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine

PhD in Traumatology and Orthopaedics


Nix, S., Smith, M., & Vicenzino, B. (2010). Prevalence of hallux valgus in the general population: A systematic review and meta-analysis. Journal of Foot and Ankle Research, 3(1). https://doi.org/10.1186/1757-1146-3-21

Vincent, J. (1994). Hallux valgus and forefoot surgery. New York: Churchill Livingstone.

Helal, B. (1975). Metatarsal osteotomy for metatarsalgia. The Journal of Bone and Joint Surgery. British volume, 57-B(2), 187-192. https://doi.org/10.1302/0301-620x.57b2.187

Trnka, H. J., Kabon, B., Zettl, R., Kaider, A., Salzer, M., & Ritschl, P. (1996). Helal metatarsalosteotomy for the treatment of metatarsalgia: a critical analysis of results. Orthopaedics, 19(5), 457-461

Muller, T., Dereymaecker, G., Victor, J., Stuer, P., & Fabry, G. (1994). Long-term functional results after the Helal osteotomy. Foot Diseases, 1, 69-77

Trnka, H., Mühlbauer, M., Zettl, R., Myerson, M. S., & Ritschl, P. (1999). Comparison of the results of the Weil and Helal osteotomies for the treatment of Metatarsalgia secondary to dislocation of the lesser Metatarsophalangeal joints. Foot & Ankle International, 20(2), 72-79. https://doi.org/10.1177/107110079902000202

Protsko, V. G., Zagorodny, N. V., & Taj, A. A. (2018). A way to eliminate metatarsalgia and deformity of the fingers with transverse flat feet. Panent 2675455. Russia. [in Russian]

Taj, A. A., Protsko, V. G., Cherevtsov, V. N., & Volkov, A. V. (2017). Comparison of the results of Helal and Weil osteotomy for the treatment of metatarsalgia in secondary dislocation in the metatarsophalangeal joints of the 2nd, 3rd and 4th metatarsal bones. Diary of Kazanskaya medical school, 3(17), 54-61. [in Russian]

Barouk, L. S. (1994). L’osteotomie cervico-cephalique de Weil dans les metatarsalgiesmedianes. Medecine et Chirurgie du Pied, 10, 23–33

Besse, J. (2017). Metatarsalgia. Orthopaedics & Traumatology: Surgery & Research, 103(1), S29-S39. https://doi.org/10.1016/j.otsr.2016.06.020

Leemrijse, T., Maestro, M., Tribak, K., Gombault, V., Devos Bevernage, B., & Deleu, P. (2012). L’ostéotomie SCARF sans ostéosynthèse dans Le traitement de l’hallux valgus. Revue de Chirurgie Orthopédique et Traumatologique, 98(8), 827-833. https://doi.org/10.1016/j.rcot.2012.07.011

Coughlin, M. J., Baumfeld, D. S., & Nery, C. (2011). Second MTP joint instability: Grading of the deformity and description of surgical repair of capsular insufficiency. The Physician and Sportsmedicine, 39(3), 132-141. https://doi.org/10.3810/psm.2011.09.1929

Wolf, M. D. (1973). Metatarsal osteotomy for the relief of painful metatarsal callosities. The Journal of Bone & Joint Surgery, 55(8), 1760-1762. https://doi.org/10.2106/00004623-197355080-00024

Barouk, L. S. (2005). The BRT proximal metatarsal osteotomy. Forefoot Reconstruction, 139-154. https://doi.org/10.1007/2-287-28937-2_3

Khurana, A., Kadamabande, S., James, S., Tanaka, H., & Hariharan, K. (2011). Weil osteotomy: Assessment of medium term results and predictive factors in recurrent metatarsalgia. Foot and Ankle Surgery, 17(3), 150-157. https://doi.org/10.1016/j.fas.2010.04.003

Maestro, M., Besse, J., Ragusa, M., & Berthonnaud, E. (2003). Forefoot morphotype study and planning method for forefoot osteotomy. Foot and Ankle Clinics, 8(4), 695-710. https://doi.org/10.1016/s1083-7515(03)00148-7

Mann, R. A., & Coughlin, M. J. (1999). Adult hallux valgus. Surgery of the foot and ankle. 7th ed. — St. Louis : Mosby

Prozorovsky, D. V., & Buznitsky, R. I. (2020). Osteotomy Helal in the surgical treatment of metatarsalgia. Orthopedics, traumatology and prosthetics, 3, 67-71. https://doi.org/10.15674/0030-59872020367-71. [in Russian]

Ibrahim, T., Beiri, A., Azzabi, M., Best, A. J., Taylor, G. J., & Menon, D. K. (2007). Reliability and validity of the subjective component of the American orthopaedic foot and ankle society clinical rating scales. The Journal of Foot and Ankle Surgery, 46(2), 65-74. https://doi.org/10.1053/j.jfas.2006.12.002