Surgery for symptomatic Freiberg’s disease: excision arthroplasty in eight patients

Surgical Management of Freiberg’s Infraction

“…A total of 59 (18.0%) postoperative complications occurred: continued pain (30), joint stiffness (9), floating toe (5), transfer lesion (3), weak dorsiflexion of the toe (2), hyperthesia over the surgical (2), 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). 15,31,33,36,45,55,59,62,64,65,68,[71][72][73] Of these complications, 28 (2.1%) did not cause pain, had resolution of pain, or improved: no pain with joint stiffness (7), no pain with floating toe (5), no pain with transfer lesion (3), weakness with dorsiflexion of the second toe improved (2), hyperthesia over the surgical scar improved (2), pain resolution with conversion of a previous Smillie procedure to implant arthroplasty (1), 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). 55,59,65,71 The most common unresolved postoperative complication was continued pain.…”

“…55,59,65,71 The most common unresolved postoperative complication was continued pain. 15,31,36,42,45,62,64,68,72,73 A total of 7 (18.4%) studies reported preoperative and postoperative dorsiflexion and plantarflexion range of motion measurements of the affected joint. 19,42,33,58,60,65,69 The mean preoperative dorsiflexion available was 20.5 ± 9.2°.…”

“…(Table 3) Thirteen (13.4%) studies reported on the results of a total of 70 joint destructive procedures (72 patients; 74 feet). 15,20,25,31,36,62,63,67,68,70,74,76,77 Joint destructive procedures performed were the following: interpositional arthroplasty (25), implant arthroplasty (23), arthroplasty (16), and metatarsal head resection (6). Of the 6 (46.2%) studies where laterality was reported there were 3 left feet and 7 right feet.…”

“…Only one case in the joint destructive category reported the Smillie Stage 4 for a metatarsal in which an arthroscopic arthroplasty was performed with good results at 24-month follow-up. 68 The Smillie stage was reported more often in the joint sparing procedure category but was not consistently paired with the procedure performed. Despite these findings the majority of procedures were performed in metatarsals of Smillie Stages 4 and 5.…”

The Functional Outcome of Four-In-One Technique: Dorsal Closing-Wedge & Shortening Osteotomy, Debridement, Micro-Fracture in the Treatment of Freiberg’s Disease

“…However, failures of conservative management are dealt with operative techniques including debridement, 7 osteotomy (either dorsal closing-wedge 8 or shortening, 9 osteochondral plug transplantation, 10 resection arthroplasty. 11 We proposed a multipronged approach to the management of Freiberg disease. A combined dorsal closing wedge with shortening of the metatarsal and joint debridement and micro-fracture for treating the Freiberg infarction was done.…”