Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Is a Weil Osteotomy?

The Weil osteotomy is a surgical procedure designed to shorten and realign the lesser metatarsal bones (second through fifth) to relieve chronic forefoot pain from overloaded metatarsal heads and instability at the metatarsophalangeal (MTP) joints. Named after the French surgeon Dr. Lowell Weil who developed and refined the technique, the procedure reliably reduces pressure on painful metatarsal heads while allowing immediate weight bearing.

At Balance Foot and Ankle, our foot surgeons perform Weil osteotomies as part of comprehensive forefoot reconstruction for patients with metatarsalgia that has failed conservative management.

The Problem the Weil Osteotomy Solves

A long or dropped metatarsal bears disproportionate plantar pressure. When the MTP joint plantar plate and collateral ligaments fail, the toe begins to sublux or dislocate dorsally, removing the soft tissue cushion from beneath the metatarsal head and concentrating painful pressure directly on bone. The Weil osteotomy shortens the metatarsal, reduces pressure under the head, and allows the MTP joint to be reduced and repaired.

The Surgical Technique

A small dorsal incision exposes the metatarsal neck. An oblique bone cut is made parallel to the ground from the dorsal metatarsal neck, allowing the head to slide proximally by 2 to 8 millimeters. A small titanium screw secures the new position. Intraoperative fluoroscopy confirms appropriate metatarsal length relative to adjacent metatarsals. Concurrent procedures include plantar plate repair, extensor tendon lengthening, and PIP joint correction for hammertoe deformity when present.

Multiple Metatarsal Correction

Metatarsalgia rarely affects only a single metatarsal. Correcting one without addressing adjacent ones can transfer pressure rather than eliminate it. Our surgeons carefully assess the metatarsal parabola preoperatively, determining which metatarsals require correction and by how much to achieve balanced load distribution.

Recovery After Weil Osteotomy

A primary advantage of the Weil osteotomy is immediate postoperative weight bearing in a flat surgical shoe. Most patients leave the surgical center bearing weight the day of surgery. The flat shoe protects the osteotomy during the 4 to 6 week bone healing period. Transition to a wide athletic shoe occurs at 6 to 8 weeks. Full activity return including athletic participation typically occurs by 4 to 6 months.

Floating Toe Consideration

Floating toe — a toe that does not fully contact the ground after surgery — is the most discussed concern following Weil osteotomy. Metatarsal shortening reduces flexor tendon tension on the toe. Mild floating toe is common initially and typically resolves as the tendons adapt over several months. Our surgeons use specific technique modifications to minimize this risk.

If you have chronic ball-of-foot pain with calluses, toe deformities, or MTP joint instability, contact Balance Foot and Ankle for evaluation. We provide comprehensive forefoot treatment throughout Southeast Michigan with same-week appointments available.

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Weil Osteotomy & Metatarsalgia Surgery in Michigan

The Weil osteotomy is a precise metatarsal shortening procedure for intractable metatarsalgia and plantar plate dysfunction. Dr. Tom Biernacki at Balance Foot & Ankle performs minimally invasive forefoot surgery at our Howell and Bloomfield Hills offices.

Learn About Our Forefoot Surgery Options | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Trnka HJ, et al. “The Weil osteotomy for treatment of dislocated lesser metatarsophalangeal joints: good outcome in 21 patients with 42 osteotomies.” Acta Orthopaedica Scandinavica. 2002;73(2):190-194.
2. Highlander P, et al. “Complications of the Weil osteotomy.” Foot and Ankle Specialist. 2011;4(3):165-170.
3. Maceira E, Monteagudo M. “Transfer metatarsalgia post hallux valgus surgery.” Foot and Ankle Clinics. 2014;19(2):285-307.

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.