The Role of Passive Plantar Flexion in Floating Toes Following Weil Osteotomy

Association between floating toe and toe grip strength in school age children: a cross-sectional study

“…First, a low TGS is associated with floating toe. Previous studies6, 16 ) reported that the windlass mechanism may be responsible for post-osteotomy floating toe. TGS is exerted mainly by the plantar intrinsic and extrinsic muscles17 ) , which play a role in the windlass mechanism.…”

“…Floating toe reportedly influences dynamic balance, stride length, and walking speed in studies from Japan. Previous studies concluded that floating toe results from excessive dorsiflexion5 ) or a lack of plantarflexion6 ) of the metatarsophalangeal joint (MTP). Fukuyama et al3 ) defined floating toe as a condition in which the toe did not contact the ground in the standing position and the weight did not shift to the toe during walking.…”

Flexor Digitorum Brevis Transfer for Floating Toe Prevention after Weil Osteotomy

“…In a cadaver study, Perez et al addressed this by shortening the plantar plate, thereby retensioning and restoring the windlass mechanism. 10 While this study showed a significant correction of the floating toe and confirmed the importance of the plantar mechanism in the development, correction, and possible prevention of the floating toe, it utilized a plantarly based incision. This approach raises concern for healing potential of the plantar plate, stiffness, and complications at the weight-bearing surface of the foot.…”

Effectiveness of the Dorsal Thermoplastic Locking Orthosis to Prevent Floating Toes in Postoperative Follow-up of Weil Osteotomies

“…45 The predictive factors identified for this complication were the amount of shortening of the metatarsals, distal osteotomy cut angle, retraction of the dorsal connective tissue, repair of the plantar plate, and the rehabilitation protocol. [54][55][56][57] Nevertheless, the cause of the floating toe after Weil osteotomy is still undefined because the evidence level of the studies available does not provide statistical validity to determine its etiology. 45 The theory of the reduction of the plantar flexor mechanism tension associated with the retraction of the dorsal structures seems to explain the 5 predictive evolution factors for floating toes.…”