Weil’s osteotomy versus distal metatarsal metaphyseal osteotomy for the treatment of metatarsalgia. A metaanalysis of outcome and complications.

Weil's osteotomy (WO) and distal metatarsal metaphyseal osteotomy (DMMO) are considered to be the gold standard of managing metatarsalgia. Stiffness and floating toe are the main disadvantages of the WO, whereas delayed union or malunion and prolonged swelling are the main complications of the DMMO. The purpose of this study is to compare these two methods, in terms of outcome and complications, through a metaanalysis of the literature. Pubmed, Google Scholar and Mendeley databases were searched for studies comparing directly the outcome of DMMO and Weil's osteotomy, with a minimum follow up of six months. The random effects model was used for the metaanalysis. The quality of studies was assessed using the MINORS criteria. Four studies were eligible for the analysis including 211 patients in total. The mean difference of the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and the visual analogue scale (VAS) among the two techniques was -1,04 (C.I.: -3,50 – 1,43) and -0,39 (CI: -0,83 – 0,08) respectively. The risk difference regarding postoperative stiffness, swelling and residual metatarsalgia was -0,09 (95% C.I.: -0,23 – 0,06), -0,17 (95% C.I.: -0,62 – 0,29) and -0,06 (95% C.I.: -0,20 – 0,08) respectively. Based on the existing literature, Weil's osteotomy and DMMO are equally safe and effective for the treatment of metatarsalgia. More studies of better quality are required, in order to extract safer and absolute conclusions regarding this topic.