Abstract
Background: Freiberg’s disease is an osteochondrosis most commonly seen in adolescent women and characterized by pain, swelling and motion restriction in the second metatarsal. The early stages of this disease can be managed with semirigid orthoses, metatarsal bars and short leg walking cast. Number of operative methods are suggested which can be used depending on the pathophysiology of the disease, including abnormal biomechanics, joint congruence and degenerative process. We evaluated the outcomes of the patients with Freiberg’s disease who were treated with dorsal closing-wedge osteotomy and resection of the metatarsal head.
Materials and Methods: 16 patients (11 female, 5 male) with a mean age of 24.5 (range 13–49 years) years who underwent dorsal closing wedge osteotomy or resection of the metatarsal head were included in this retrospective study. Second metatarsal was affected in 13 and third metatarsal in three patients. According to the Smillie’s classification system, ten patients had type IV osteonecrosis and six patients had type V. The results of the patients were evaluated using the lesser metatarsophalangeal-interphalangeal (LMPI) scale.
Results: According to the LMPI scale, the postoperative scores for the osteotomy and excision groups were 86 (range 64–100) and 72.6 (range 60–85), respectively. In the osteotomy group, mean passive flexion restriction was 18° (range 0°–35°) and mean passive extension restriction was 12° (range 0°–25°). Mean metatarsal shortening was 2.2 mm (range 2–4 mm) in the osteotomy group as opposed to 9.8 mm (range 7–14 mm) in the excision group. Significant pain relief was obtained in both groups following the surgery.
Conclusion: The decision of performing osteotomy or resection arthroplasty in the patients with advanced.stage Freiberg’s disease should be based on the joint injury and the patients should be informed about the cosmetic problems like shortening which may arise from resection.
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References
Smillie IS. Freiberg’s infarction (Kohler’s second disease). J Bone Joint Surg Br 1957;39:580.
Farrar MJ, Walker AP. Freiberg’s disease following fracture of the second metatarsal bone. Foot 1997;7:52–3.
Murphy AG, Richardson GE. Lesser toe abnormalities. Campbell’s Operative Orthopaedics. 11th ed., Vol. 2. St. Louis, Philadelphia: Mosby; 2008. p. 1252–53.
Ihedioha U, Sinha S, Campbell AC. Surgery for symptomatic Freiberg’ s disease: Excision arthroplasty in eight patients. Foot 2003;13:143–5.
Freiberg JA. The diagnosis and treatment of common painful conditions of the foot. Instr Course Lect 1957;14:238–47.
Gauthier G, Elbaz R. Freiberg’s infraction: A subchondral bone fatigue fracture. A new surgical treatment. Clin Orthop Relat Res 1979;93–5.
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349–53.
Shih AT, Quint RE, Armstrong DG, Nixon BP. Treatment of Freiberg’s infraction with the titanium hemi-implant. J Am Podiatr Med Assoc 2004;94:590–3.
Hayashi K, Ochi M, Uchio Y, Takao M, Kawasaki K, Yamagami N. A new surgical technique for treating bilateral Freiberg disease. Arthroscopy 2002;18:660–4.
McGlamry ED, Ruch JA. Status of implant arthroplasty of the lesser metatarsophalangeal joints. J Am Podiatry Assoc 1976;66:155–64.
Chao KH, Lee CH, Lin LC. Surgery for symptomatic Freiberg’s disease: Extraarticular dorsal closing-wedge osteotomy in 13 patients followed for 2-4 years. Acta Orthop Scand 1999;70:483–6.
Lee SK, Chung MS, Baek GH, Oh JH, Lee YH, Gong HS. Treatment of Freiberg disease with intraarticular dorsal wedge osteotomy and absorbable pin fixation. Foot Ankle Int 2007;28:43–8.
Sansone V, Morandi A, Dupplicato P, Ungaro E. Treatment of late-stage Freiburg’s disease using a temporary metal interpositional device. J Bone Joint Surg Br 2010;92:807–10.
Miyamoto W, Takao M, Uchio Y, Kono T, Ochi M. Late-stage Freiberg disease treated by osteochondral plug transplantation: A case series. Foot Ankle Int 2008;29:950–5.
Ozkan Y, Oztürk A, Ozdemir R, Aykut S, Yalçin N. Interpositional arthroplasty with extensor digitorum brevis tendon in Freiberg’s disease: A new surgical technique. Foot Ankle Int 2008;29:488–92.
Hofstaetter SG, Hofstaetter JG, Petroutsas JA, Gruber F, Ritschl P, Trnka HJ. The Weil osteotomy: A seven-year followup. J Bone Joint Surg Br 2005;87:1507–11.
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Özkul, E., Gem, M., Alemdar, C. et al. Results of two different surgical techniques in the treatment of advanced-stage Freiberg’s disease. IJOO 50, 70–73 (2016). https://doi.org/10.4103/0019-5413.173514
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DOI: https://doi.org/10.4103/0019-5413.173514