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A new classification for Freiberg's disease.

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This study introduces a new CT-based classification for Freiberg's osteochondrosis, aiding surgical planning. Isolated disease in zone 1 on CT scans indicates suitability for osteotomy.

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Area of Science:

  • Orthopedics
  • Radiology
  • Surgical Planning

Background:

  • Freiberg's osteochondrosis is an uncommon cause of foot pain.
  • No current classification system guides surgical treatment for this condition.
  • A need exists for a reproducible method to plan surgical interventions.

Purpose of the Study:

  • To develop a simple, reproducible CT-based classification for Freiberg's osteochondrosis.
  • To aid in preoperative planning for surgical treatment, specifically determining the need for osteotomy.

Main Methods:

  • Retrospective review of 24 CT scans of Freiberg's osteochondrosis diagnoses.
  • Anonymized CT scans were analyzed by three specialists.
  • A classification system was developed based on dividing the metatarsal head into plantar (zone 1) and dorsal (zone 2) on the widest sagittal slice.

Main Results:

  • All 24 cases involved the second metatarsal.
  • 18 patients had disease confined to zone 1, deemed suitable for osteotomy.
  • 6 patients had disease in both zones, suitable for debridement or arthroplasty.
  • High inter-observer (95.8% agreement) and intra-observer (100%) reliability was achieved.

Conclusions:

  • A two-zone classification of the metatarsal head on CT scans provides a reproducible method for surgical planning in Freiberg's osteochondrosis.
  • Patients with isolated zone 1 disease are suitable candidates for osteotomy.
  • This classification simplifies preoperative decision-making for Freiberg's osteochondrosis treatment.