Modified Weil Osteotomy for the Treatment of Freiberg's Disease

Abstract

BackgroundNumerous metatarsal osteotomies have been developed for the treatment of Freiberg's disease. The purpose of this study was to evaluate the clinical outcomes of modified Weil osteotomy in the treatment of Freiberg's disease.MethodsFrom November 2001 to July 2008, nineteen patients (twenty feet), treated surgically for Freiberg's disease, were included in this study. The average age of the patients was 33.6 years (range, 17 to 62 years), the mean follow-up period was 71.6 months (range, 41 to 121 months). Clinical outcomes were evaluated according to visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the patients' subjective satisfaction and range of motion (ROM) of metatarsophalangeal (MTP) joint. In the radiologic evaluation, initial metatarsal shortening by Freiberg's disease compared to opposite site, metatarsal shortening after modified Weil osteotomy compared with preoperative radiography and term for radiologic union were observed.ResultsVAS showed improvement from 6.2 ± 1.4 to 1.4 ± 1.5 at last follow-up (p < 0.0001). Points of AOFAS score increased from 63.3 ± 14.9 to 80.4 ± 5.6 (p < 0.0001). ROM of MTP joints also improved from 31.3 ± 10.1 to 48.3 ± 13.0 degrees at last follow-up (p < 0.0001). According to Smillie's classification system, there was no significant improvement of VAS, AOFAS score and ROM between early stages (stage I, II, and III) and late stages (stage IV and V). Out of twenty cases, nineteen (95%) were satisfied, reporting excellent or good results.ConclusionsModified Weil osteotomy is believed to be a useful method for the treatment of Freiberg's disease, not only in the early stages but also in the late stages. It relieves pain and improves function via shortening of metatarsals and restoration of MTP joint congruency.

Surgical Management of Freiberg’s Infraction

“…The search for potentially eligible information yielded a total of 85 references of which 38 (44.7%) met all of the inclusion criteria 14,15,19,20,22,[23][24][25]27,31,33,42,45, (Table 2). The level of evidence for the included studies was Level 4 and 5, therapeutic.…”

“…Complete resolution of pain and full return to activity was noted for 9 (81.8%) of the 11 metatarsals in which autogenous knee implant was performed ( A total of 37 (14.4%) postoperative complications occurred: continued pain (12), joint stiffness (7), floating toe (1), transfer lesion (3), hardware irritation (2), broken hardware (1), stress fracture after removal of external fixation pins (1), superficial infection (1), sinus tract (1), transfer metatarsalgia (1), delayed union (1), and development of a Morton's neuroma (1). 36,42,45,55,59,64,65,[71][72][73] Of these complications, 24 resolved or did not cause pain: resolution of pain with conversion of previous Smillie's procedure with implant arthroplasty (1), no pain with joint stiffness (7), no pain with floating toe (5), no pain with transfer lesion (3), Morton's neuroma resolved with neurectomy (1), hardware irritation resolved with removal (1), no pain with broken hardware (1), complete union of delayed union (1), complete union of stress fractures from external fixation pin sites (1), no pain with transfer metatarsalgia (1), resolution of superficial infection (1), resolution of sinus tract with hardware removal (1). 36,42,45,55,59,64,65,[71][72][73] The most common unresolved complication postoperative was continued pain.…”

“…36,42,45,64,72,73 A total of 6 (20.7%) studies reported preoperative and postoperative dorsiflexion and plantarflexion range of motion measurements of the affected joint. 19,33,42,58,60,65,69 The mean preoperative dorsiflexion available was 20.5 ± 9.2°. The mean preoperative plantarflexion available was 28.1 ± 16.2°.…”

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

“…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].…”

Arthroscopic Dorsal Closing-Wedge Osteotomy of Metatarsal Head for Management of Freiberg Infraction

“…Operative treatment is indicated if conservative treatment fails to relieve the pain, and it can be divided into joint-preserving and joint-reconstructing procedures 1 . These procedures include intra- or extra-articular dorsal closing-wedge osteotomy, osteochondral transplant, metatarsal shortening osteotomy, marrow stimulation, and micronized allograft cartilage matrix 3, 4, 5, 7, 8, 9, 10, 11. Osteotomy improves pain and function in terms of shortening the metatarsal length and restoring the metatarsal head's sphericity and metatarsophalangeal joint congruency 6, 12, 13.…”