Advances in the Causes and Treatment of Floating Toes after the Weil Osteotomy: A Scoping Review

Abstract

The floating toe deformity is classified as a forefoot deformity wherein the distal portion of the toe does not establish touch with the ground, resulting in a suspended or elevated position while the finger is in a relaxed state. At first, it garnered considerable interest as a complication It is worth noting that this condition is particularly common in children under the age of 8, which usually disappears as the individual reaches maturity. Studies have shown that with the aggravation of floating toe deformity, its adverse effects on patients' gait and overall quality of life also increase. Despite the prevalence of floating toe deformity in clinical settings, there is a lack of comprehensive literature investigating its underlying causes and potential preventive strategies. This scope review follows the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) statement guidelines for scope reviews. The literature was obtained from various full-text databases, including China National Knowledge Infrastructure Database (CNKI), Wanfang Database, PubMed, and Web of Science Database. Our search focused on published literature related to floating toes, Weil osteotomy, and distal metatarsal osteotomy, up until March 1, 2023. The literature search and data analysis are conducted by two independent reviewers. If there are any disagreements, a third researcher will participate in the discussion and negotiate a decision. Furthermore, two experienced foot and ankle surgeons conducted a thorough literature analysis for this review. Sixty-two articles were included. Through the clinical analysis of the structural changes of the forefoot before and after operation, the classification of floating toe was described, the causes of pathological floating toe were summarized, and the possible intervention measures for the disease were put forward under the advice of foot and ankle surgery experts. We comprehensively summarize the current knowledge system about the etiology of floating toe and put forward the corresponding intervention strategy. We recommend that future studies will focus on the improvement of surgical procedures, such as the combination of Weil osteotomy, proximal interphalangeal (PIP) arthrodesis and flexor tendon arthrodesis.

Keywords

Floating toe / Distal metatarsal osteotomy / Interventions / Surgical complications / Weil osteotomy

References

[1] McGlamryE. Floating toe syndrome. J Am Podiatr Med Assoc. 1982;72(11):561–568.

[2] FukuyamaK, Maruyama H. Occurrence of floating toe from the viewpoint of the structure of foot arch. J Phys Ther Sci. 2011;23(1):33–36.

[3] VandeputteG, Dereymaeker G, SteenwerckxA, PeeraerL. The Weil osteotomy of the lesser metatarsals: a clinical and pedobarographic follow-up study. Foot Ankle Int. 2000;21(5):370–374.

[4] MiguesA, Slullitel G, BilbaoF, CarrascoM, SolariG. Floating-toe deformity as a complication of the Weil osteotomy. Foot Ankle Int. 2004;25(9):609–613.

[5] RamisettyN, GreissM. The Weil osteotomy: a seven-year follow-up. J Bone Joint Surg Br. 2007;89(2):280.

[6] HighlanderP, VonHerbulis E, GonzalezA, BrittJ, Buchman J. Complications of the Weil osteotomy. Foot Ankle Spec. 2011;4(3):165–170.

[7] GargR, Thordarson DB, SchrumpfM, CastanedaD. Sliding oblique versus segmental resection osteotomies for lesser metatarsophalangeal joint pathology. Foot Ankle Int. 2008;29(10):1009–1014.

[8] WagnerE, O'Connell LA, RadkievichR, CaicedoN, Mococain P, WagnerP. Incidence of and functional significance of floating toe after Weil osteotomy. Foot Ankle Orthop. 2019;4(4):2473011419891956.

[9] ReddyVB. Metatarsal osteotomies: complications. Foot Ankle Clin. 2017;23(1):47–55.

[10] MonteagudoM, Maceira E. Evolution of the Weil osteotomy: the triple osteotomy. Foot Ankle Clin. 2019;24(4):599–614.

[11] SchuhR, TrnkaHJ. Metatarsalgia: distal metatarsal osteotomies. Foot Ankle Clin. 2011;16(4):583–595.

[12] TrnkaH-J, NyskaM, ParksBG, Myerson MS. Dorsiflexion contracture after the Weil osteotomy: results of cadaver study and three-dimensional analysis. Foot Ankle Int. 2001;22(1):47–50.

[13] PerezHR, ReberLK, ChristensenJC. The role of passive plantar flexion in floating toes following Weil osteotomy. J Foot Ankle Surg. 2008;47(6):520–526.

[14] O'KaneC, Kilmartin T. The surgical management of central metatarsalgia. Foot Ankle Int. 2002;23(5):415–419.

[15] HofstaetterS, Hofstaetter J, PetroutsasJ, GruberF, Ritschl P, TrnkaH-J. The Weil osteotomy: a seven-year follow-up. J Bone Joint Surg Br. 2005;87(11):1507–1511.

[16] CoughlinM. Hallux valgus. Instr Course Lect. 1997;46:357–391.

[17] SuhJW, JangH-S, ParkH-W. Iatrogenic second transfer metatarsalgia and the first metatarsal shortening and elevation after scarf osteotomy. Foot Ankle Surg. 2022;28(4):464–470.

[18] MelamedEA, SchonLC, MyersonMS, Parks BG. Two modifications of the Weil osteotomy: analysis on sawbone models. Foot Ankle Int. 2002;23(5):400–405.

[19] LeeLC, Charlton TP, ThordarsonDB. Flexor digitorum brevis transfer for floating toe prevention after Weil osteotomy: a cadaveric study. Foot Ankle Int. 2013;34(12):1724–1728.

[20] DernerR, MeyrAJ. Complications and salvage of elective central metatarsal osteotomies. Clin Podiatr Med Surg. 2009;26(1):23–35.

[21] ValleyB, ReeseH. Guidelines for reconstructing the metatarsal parabola with the shortening osteotomy. J Am Podiatr Med Assoc. 1991;81(8):406–413.

[22] MaestroM, BesseJ-L, RagusaM, Berthonnaud E. Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin. 2003;8(4):695–710.

[23] StoupineA, SinghBN. A cadaveric study of metatarsal length and its function in the metatarsal formula and forefoot pathology. J Am Podiatr Med Assoc. 2018;108(3):194–199.

[24] Godoy-SantosAL, Diniz Fernandes T, LuzoC, OrtizRT, SakakiM, WeilL. Effectiveness of the dorsal thermoplastic locking orthosis to prevent floating toes in postoperative follow-up of Weil osteotomies: pilot study. Foot Ankle Spec. 2014;7(5):356–362.

[25] GrimesJ, Coughlin M. Geometric analysis of the Weil osteotomy. Foot Ankle Int. 2006;27(11):985–992.

[26] BougiouklisD, Tyllianakis M, DeligianniD, PanagiotopoulosE, Bougiouklis D, TyllianakisM, et al. Biomechanical analysis of the change of the metatarsophalangeal Joint's Center of Rotation after Weil and Triple Weil Osteotomies: a comparative cadaveric study. Cureus. 2022;14(2):e21866.

[27] BobrovD, Slinjakov L, RiginN. The primary metatarsalgia: pathogenesis, biomechanics and surgical treatment. Vestn Ross Akad Med Nauk. 2017;72(1):53–58.

[28] BennettAJ, McLeodI. An adaptation of Weil's osteotomy of the lesser metatarsal neck. J Foot Ankle Surg. 2009;48(4):516–517.

[29] WeilL, SungW, WeilLS, Malinoski K. Anatomic plantar plate repair using the Weil metatarsal osteotomy approach. Foot Ankle Spec. 2011;4(3):145–150.

[30] DohleJ, Marques A. Reconstruction of the plantar plate of the metatarsophalangeal joint using a dorsal transarticular approach. Oper Orthop Traumatol. 2021;33:422–429.

[31] CookJJ, Johnson LJ, CookEA. Anatomic reconstruction versus traditional rebalancing in lesser metatarsophalangeal joint reconstruction. J Foot Ankle Surg. 2018;57(3):509–513.

[32] SorensenMD, WeilL. Lesser metatarsal osteotomy. Clin Podiatr Med Surg. 2015;32(3):275–290.

[33] MoraesMR, Cavalcante MLC, LeiteJAD, FerreiraFV, CastroAJO, SantanaMG. Histomorphometric evaluation of mechanoreceptors and free nerve endings in human lateral ankle ligaments. Foot Ankle Int. 2008;29(1):87–90.

[34] AttingerCE, EvansKK, BulanE, Blume P, CooperP. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006;117(7S):261S–293S.

[35] PetersenW, LankesJ, PaulsenF, Hassenpflug J. The arterial supply of the lesser metatarsal heads: a vascular injection study in human cadavers. Foot Ankle Int. 2002;23(6):491–495.

[36] RathB, Notermans H-P, FranzenJ, KnifkaJ, Walpert J, FrankD, et al. The microvascular anatomy of the metatarsal bones: a plastination study. Surg Radiol Anat. 2009;31:271–277.

[37] NguyenU-S, Hillstrom HJ, LiW, DufourAB, KielDP, Procter-GrayE, et al. Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston study. Osteoarthr Cartil. 2010;18(1):41–46.

[38] Piqué-VidalC, Solé MT, AntichJ. Hallux valgus inheritance: pedigree research in 350 patients with bunion deformity. J Foot Ankle Surg. 2007;46(3):149–154.

[39] JiaJ, LiJ, QuH, LiM, ZhangS, Hao J, et al. New insights into hallux valgus by whole exome sequencing study. Exp Biol Med. 2021;246(14):1607–1616.

[40] FujimakiT, WakoM, KoyamaK, Furuya N, ShinoharaR, OtawaS, et al. Prevalence of floating toe and its relationship with static postural stability in children: the Yamanashi adjunct study of the Japan environment and Children's study (JECS-Y). PloS One. 2021;16(3):e0246010.

[41] WakoM, Fujimaki T, KoyamaK, FuruyaN, Shinohara R, OtawaS, et al. A cross-sectional study on the correlations between floating toe, plantar arch posture, and body composition in 8-year-old children. Foot Ankle Surg. 2022;28(7):1035–1039.

[42] ArakiT, MasudaT, JinnoT, Morita S. Incidence of floating toe and its association with the physique and foot morphology of Japanese children. J Phys Ther Sci. 2015;27(10):3159–3162.

[43] TasakaS, Matsubara K, NishiguchiS, FukutaniN, Tashiro Y, ShirookaH, et al. Association between floating toe and toe grip strength in school age children: a cross-sectional study. J Phys Ther Sci. 2016;28(8):2322–2325.

[44] WakoM, KoyamaK, FuruyaN, Shinohara R, OtawaS, KobayashiA, et al. Relationship between floating toes condition and lower limb muscle weight in 8-year-old children: the Yamanashi adjunct study of the Japan environment and Children's study (JECS-Y). J Phys Ther Sci. 2023;35(3):252–256.

[45] BalasubramanianG, Vas P, ChockalingamN, NaemiR. A synoptic overview of neurovascular interactions in the foot. Front Endocrinol. 2020;11:308.

[46] KlingeSA, McClure P, FellarsT, DiGiovanniCW. Modification of the Weil/Maceira metatarsal osteotomy for coronal plane malalignment during crossover toe correction: case series. Foot Ankle Int. 2014;35(6):584–591.

[47] KimJ, ChoiWJ, ParkYJ, Lee JW. Modified Weil osteotomy for the treatment of Freiberg's disease. Clin Orthop Surg. 2012;4(4):300–306.

[48] EdmondsonM, SherryK, AfolayanJ, Armitage A, SkyrmeA. Case series of 17 modified Weil's osteotomies for Freiberg's and Köhler's II AVN, with AOFAS scoring pre-and post-operatively. Foot Ankle Surg. 2011;17(1):19–24.

[49] de CésarPC, Torres AC, OlianiCHP, de AbreuMR. Influence of the length ratio between second and third metatarsals after modified Weil osteotomy on clinical outcomes. J Foot Ankle Surg. 2022;61(5):1007–1012.

[50] HerzogJL, Goforth WD, StonePA, PadenMH. A modified fixation technique for a decompressional shortening osteotomy: a retrospective analysis. J Foot Ankle Surg. 2014;53(2):131–136.

[51] MartinKD, McBride T, WakeJ, Van BurenJP, DewarC. Comparison of visual analog pain score reported to physician vs nurse in nonoperatively treated foot and ankle patients. Foot Ankle Int. 2018; 39(12):1444–1448.

[52] BougiouklisD, Tyllianakis M, DeligianniD, PanagiotopoulosE, Bougiouklis D, TyllianakisM, et al. Comparison of the Weil and triple Weil osteotomies: a clinical retrospective study. Cureus. 2022;14(2):e22220.

[53] EspinosaN, Myerson MS, De RetanaPF, MaceiraE. A new approach for the treatment of metatarsalgia: the triple Weil osteotomy. Techniques Foot Ankle Sur. 2007;6(4):254–263.

[54] Pérez-MuñozI, Escobar-AntónD, Sanz-Gómez TA. The role of Weil and triple Weil osteotomies in the treatment of propulsive metatarsalgia. Foot Ankle Int. 2012;33(6):501–506.

[55] de CesarNC, Schmidt EL, LaleveeM, MansurNSB. Correction to: flexor tenodesis procedure in the treatment of lesser toe deformities. Arch Orthop Trauma Surg. 2022;142(11):3139.

[56] LandsmanA, CookE, CookJ. Tenotomy and tendon transfer about the forefoot, midfoot and hindfoot. Clin Podiatr Med Surg. 2008;25(4):547–569.

[57] MyersSH, SchonLC. Forefoot tendon transfers. Foot Ankle Clin. 2011;16(3):471–488.

[58] NeryC, Baumfeld D. Lesser metatarsophalangeal joint instability: treatment with tendon transfers. Foot Ankle Clin. 2018;23(1):103–126.

[59] VeljkovicA, Lansang E, LauJ. Forefoot tendon transfers. Foot Ankle Clin. 2014;19(1):123–137.

[60] WaizyH, Abbara-Czardybon M. Arthodesis of the proximal and distal interphalangeal joint. Oper Orthop Traumatol. 2014;26:307–323.

[61] DöhnerC, Beyerle H, GrawJA, SoostC, Burchard R. Biomechanical comparison of different implants for PIP arthrodesis. Foot Ankle Surg. 2023;29:518–524.

[62] NagamotoH, KimuraR, HataE, Kumai T. Disabled throwing shoulder/elbow players have high rates of impaired foot function. Res Sports Med. 2023;31(5):679–686.

[63] YanagiyaT, HataK, TakeshitaT, Noro H, YoshidaT, KoyamaM, et al. Athletic event-specific characteristics in floating toes during the static standing posture. J Phys Ther Sci. 2020;32(5):342–347.

RIGHTS & PERMISSIONS

2024 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.