The Well distal shortening osteotomy of the lesser metatarsals has been used by the author since June 1992, particularly in the treatment of metatarsalgia. Its advantages are a direct approach to the metatarsophalangeal (MP) joint and the metatarsal head, providing not only correction of the deformity, but accurate control of the metatarsal shortening, primary healing and early functional recovery thanks to the strong fixation allowed by the twist-off screw. Its disadvantage is the limitation of MP articular range motion, which is temporary in most cases. The role of the Well osteotomy in metatarsalgia is to bring the metatarsal head behind the callus and to provide an axial decompression resolving the hammer toe deformity or MP luxations that are increasing or resulting in metatarsalgia. In cases of metatarsalgia resulting from the first ray insufficiency, the Well osteotomy is a fair, reliable and efficient procedure; it is also good in cases when the small metatarsal bones are too long. However, shortening the metatarsal bones has to be part of general forefoot therapeutic management. In isolated metatarsalgia, the indication may be slightly difficult, indicating a ''slimming'' resection. In contrast, both in important metatarsalgia, and generally in severe forefoot disorders, the Well osteotomy, together with the scarf osteotomy, constitutes a real surgical improvement, opening a new means of articular conservative treatment of severe static disorders.
