Dorsiflexion Osteotomy in Freiberg's Disease

Abstract

A retrospective study of the postsurgical results of 10 patients who had dorsiflexion osteotomy was undertaken. Patient satisfaction, clinical findings, and roentgenographic measurements were all carefully evaluated after an average duration of follow-up of 36.5 months. The procedure gave excellent results for all patients, with minimal loss of metatarsophalangeal motion and an average radiological metatarsal shortening of 2.3 mm and no postoperative metatarsalgia. The authors believe that the dorsiflexion osteotomy is a reasonable treatment for symptomatic Freiberg's disease. The procedure is reliable and not destructive, should further treatment be necessary.

Surgery for symptomatic Freiberg's disease: Extraarticular dorsal closing-wedge osteotomy in 13 patients followed for 2-4 years

“…Although Freiberg considered this disorder to be secondary to acute trauma, a review of the literature indicates that many patients have no history of trauma (Kinnard and Lirette 1989). Our finding that almost half of our patients engaged in activities or occupations that would place stress on the metatarsal head Cjumping) suggests that repeated loading, with subsequent stress fracture of the metatarsal head, may play a key role in the etiology of Freiberg's infarction.…”

Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results

“…Accordingly, removal of the cerclage wire is required following bone union. Kinnard et al used an absorbable suture to fix the intra-articular closing-wedge osteotomy site [8], but fixation using absorbable sutures is relatively weak and is thought to cause a loss of reduction and/or synostosis failure [9]. Chao et al reported temporal cross-pinning using K-wire in 13 cases [3].…”

“…Kinnard and Lirette performed intra-articular dorsal closedwedge osteotomies to treat 15 cases of late-stage Freiberg disease [8]. They reported that the average amount of brachymetatarsia observed following surgery was 2.5 mm.…”

“…Surgical treatment is typically only performed when conservative therapy fails. Although various operative procedures, including resection arthroplasty, joint debridement, osteotomy, and osteochondral transplant, have been reported, no consensus regarding the best surgical approach has been reached to date [2][3][4][5][6][7][8][9][10][11][12]. Gauthier and Elbaz reported good results for dorsal intra-articular closingwedge osteotomy procedures regardless of the disease stage [4].…”

“…In the report by Gauthier and Elbaz, cerclage wire was used to fix the osteotomy site [4]; however, tendinitis occurred in the extensor tendon, and wire removal was required. Kinnard used an absorbable suture, but these types of sutures are reportedly too weak for fixing [8]. Chao used a temporal cross-pinning of Kirschner wire (K-wire) for fixation [3].…”