What Is a Weil Osteotomy?
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
A Weil osteotomy is a surgical procedure that shortens and slightly depresses the head of a lesser metatarsal bone to relieve pressure and pain in the ball of the foot (metatarsalgia). Named after French podiatric surgeon Loïc Weil who described it in the 1980s, the procedure uses a specific oblique bone cut that allows controlled repositioning of the metatarsal head without disrupting the surrounding soft tissues excessively.
The Weil osteotomy is one of the most commonly performed forefoot procedures worldwide, with an extensive evidence base and predictable outcomes for appropriately selected patients.
Indications for Weil Osteotomy
The Weil osteotomy addresses several related forefoot pathologies:
- Metatarsalgia: Chronic pain beneath the metatarsal heads from overloading, most often the second and third metatarsals
- Plantar plate tear: Degeneration of the plantar plate ligament at the lesser MTP joint, causing toe instability and crossover toe deformity
- Freiberg’s disease: Avascular necrosis of the metatarsal head (usually second), causing chronic pain and joint collapse
- Hammertoe correction: As an adjunct to hammertoe repair when metatarsal prominence contributes to recurrence
- Dislocation of lesser MTP joint: Restoring joint congruency when the toe has deviated significantly
The Surgical Technique
A dorsal (top-of-foot) incision is made over the affected metatarsal. Through the joint, an oblique cut is made through the metatarsal neck at approximately 20–25 degrees relative to the plantar surface. The metatarsal head slides proximally (shortening the metatarsal) and slightly plantarly (depressing it). The exact amount of shortening is planned preoperatively from weight-bearing X-rays — typically 3–8mm — to normalize the metatarsal parabola (the arc formed by metatarsal head positions). A single small screw or K-wire secures the repositioned fragment.
Recovery
Following Weil osteotomy, patients are typically allowed to bear weight in a post-operative shoe immediately. The post-operative shoe keeps weight off the forefoot by shifting load to the heel. Most patients progress to a normal shoe at 4–6 weeks, though full resolution of swelling takes 3–6 months.
Physical therapy exercises focusing on toe flexion and MTP joint mobilization are critical in the early recovery period — one of the most important postoperative considerations is preventing the “floating toe” complication (see below).
Potential Complications
Floating Toe
The most common complication after Weil osteotomy is a floating toe — the operated toe doesn’t contact the ground during stance, caused by disruption of the intrinsic muscle-tendon balance during surgery. Rates range from 15–30% in various series. Aggressive early toe flexion exercises (picking up marbles, towel curls) and buddy taping to adjacent toes are used to prevent and treat this complication. Most cases are mild and improve over 6–12 months.
Transfer Metatarsalgia
Excessive shortening of one metatarsal can shift load to adjacent metatarsals, creating new pain. Careful preoperative planning to preserve appropriate metatarsal length relationships minimizes this risk.
Outcomes
Published series consistently report 80–90% patient satisfaction after Weil osteotomy for metatarsalgia. Pain relief is reliable, and most patients return to normal footwear and activity levels. The procedure is particularly effective when the underlying diagnosis is accurate and the amount of metatarsal shortening is appropriately calibrated to the individual foot’s anatomy.
Foot or Ankle Pain? We Can Help.
Balance Foot & Ankle — Howell & Bloomfield Township, MI
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More Podiatrist-Recommended Surgery Essentials
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Watch: Metatarsalgia Treatment [BEST Ball of Foot Pain RELIEF 2024] — MichiganFootDoctors YouTube
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Max-cushion recovery sandal — comfort for post-surgical swelling.
Hoka Bondi 9
Max-cushion walking shoe — ease into return-to-walking post-surgery.
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When to See a Podiatrist
Foot and ankle surgery in 2026 is dramatically different than a decade ago — most procedures are now minimally-invasive, outpatient, and allow weight-bearing within days. Balance Foot & Ankle surgeons have performed 3,000+ foot/ankle surgeries with modern techniques. If another surgeon has recommended a traditional open procedure, a second opinion may reveal a faster, less-invasive option.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Township
Differential Diagnosis: What Else Could It Be?
Not every case of metatarsalgia / 2nd mtp capsulitis is straightforward. In our clinic we routinely rule out three look-alike conditions before confirming the diagnosis. If your symptoms don’t match the classic presentation, one of these may explain the pain — which is why physical exam matters more than self-diagnosis.
| Condition | How It Differs |
|---|---|
| Morton’s neuroma | Burning pain into 3rd-4th toes, positive Mulder’s click, numbness between the toes. |
| Stress fracture (2nd or 3rd metatarsal) | Point tenderness on the shaft (not the head), activity-related, callus seen on later X-ray. |
| Plantar plate tear | Positive drawer test at 2nd MTP, toe begins to “float” in extension, progressive toe deformity. |
Red Flags — When to See a Podiatrist Now
Seek expert evaluation at Balance Foot & Ankle if you notice any of the following:
- Second toe drifting, crossing over, or “floating”
- Inability to bear weight on the ball of the foot
- Point tenderness suggesting stress fracture
- Diabetic + forefoot wound (urgent)
Call (810) 206-1402 or request an appointment. For an urgent foot or ankle problem, call (810) 206-1402 and we’ll find the soonest opening.
In Our Clinic: What We See
Clinical perspective from Dr. Tom Biernacki, DPM — Balance Foot & Ankle, Howell & Bloomfield Township, MI:
In our clinic, metatarsalgia patients describe a deep ache under the ball of the foot, often pointed at the 2nd metatarsal head. The pain is worse barefoot or on hard surfaces. When we see early 2nd-toe drift or a positive “vertical drawer” test at the 2nd MTP joint, we suspect plantar plate injury, which changes the management plan significantly. Most simple metatarsalgia responds to a metatarsal pad placed PROXIMAL to the metatarsal heads (not on them), stiff-soled rocker shoes, and short-term NSAIDs. Plantar plate tears may need taping, toe crest pads, or surgical repair.
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Appointments available in Howell and Bloomfield Township, Michigan.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.