[Dorsal closing-wedge osteotomy in the treatment of Freiberg's disease]

We evaluated the midterm results of debridement, synovectomy, and dorsal closing-wedge osteotomy in the treatment of metatarsal head osteochondrosis (Freiberg's disease).

Nineteen patients (17 females, 2 males; mean age 26 years; range 13 to 49 years) were treated with debridement, synovectomy, and dorsal closing-wedge osteotomy for metatarsal head osteochondrosis. The main presenting symptom was pain on walking or sports activities. The second metatarsal head was affected in 16 patients, the third in two patients, and both heads in one patient. Four patients had a history of trauma, while the remaining patients had a history of standing for long hours. According to the Smillie's classification, four patients had type 5, 12 patients had type 4, and three patients had type 3 osteonecrosis. After osteotomy, the smooth and healthy plantar surface of the metatarsal head faced the phalangeal cartilage. The mean follow-up period was 41 months (range 15 to 88 months). The results were assessed by the Lesser Metatarsophalangeal-Interphalangeal Scale by Kitaoka et al.

The results were excellent in seven patients (36.8%), good in nine patients (47.4%), and poor in three patients (15.8%). Poor results were seen in two patients with type 5, and one patient with type 4 osteonecrosis, all of whom developed aseptic necrosis in the metatarsal head and shortening of about 4 mm. One patient underwent resection arthroplasty. The mean flexion and extension losses were 15 degrees (range 0 degrees to 30 degrees ) and 10 degrees (range 0 degrees to 20 degrees ), respectively. The mean shortening in the metatarsal length was 1.6 mm (range 1 to 4 mm), postoperatively. No instances of infection, nonunion, or arthrosis were encountered.

Treatment with debridement, synovectomy, and dorsal closing-wedge osteotomy yields successful results in Freiberg's disease.