The role of passive plantar flexion in floating toes following Weil osteotomy

Floating toes are a common complication following Weil osteotomy. The toes are passively plantarflexed via the windlass mechanism, which may play a role in floating toe. Five cadaver lower limb specimens were loaded on a custom frame and 3 different interventions were tested, including control group, Weil osteotomy group, and Weil osteotomy plus plantar plate-shortening group. The extensor tendon to the second toe was loaded with 20 Newtons of tension during the trials, and non-weight-bearing and simulated weight-bearing radiographs were taken to measure the metatarsophalangeal joint extension angle. The extension angle passively plantarflexed 11.20 degrees +/- 3.43 degrees in the control group, 0.40 degrees +/- 0.89 degrees in the Weil osteotomy group, and 8.00 degrees +/- 1.41 degrees in the Weil osteotomy plus plantar plate-shortening group. Comparison of the amount of passive plantarflexion between the groups revealed statistically significant changes between the control and Weil osteotomy groups (P = .0001), and the Weil osteotomy compared with the Weil osteotomy plus plantar plate-shortening (P < .0001); whereas no statistically significant difference was observed between the control and Weil osteotomy plus plantar plate-shortening groups (P = .0893). These results support the idea that the toes undergo passive plantar flexion due to the windlass mechanism, which is dampened by the Weil osteotomy. Dampening of the windlass mechanism may be responsible for floating toe following a Weil osteotomy.