Dorsal closing-wedge osteotomy in the treatment of Freibergʹs disease

Objectives: We evaluated the midterm results of debride¬ment, synovectomy, and dorsal closing-wedge osteotomy in the treatment of metatarsal head osteochondrosis (Freibergʹs disease). Methods: Nineteen patients (17 females, 2 males; mean age 26 years; range 13 to 49 years) were treated with debride- ment, synovectomy, and dorsal closing-wedge osteotomy for metatarsal head osteochondrosis. The main presenting symptom was pain on walking or sports activities. The sec¬ond 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 S millieʹs 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. Results: 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° (range 0° to 30°) and 10° (range 0° to 20°), 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. Conclusion: Treatment with debridement, synovectomy, and dorsal closing-wedge osteotomy yields successful results in Freibergʹs disease.