Joint Debridement and Metatarsal Remodeling in Freiberg’s Infraction

Abstract

Freiberg's infraction is an osteochondrosis that is characterized by osteonecrosis of the metatarsal head, with pain and tenderness around the metatarsophalangeal joint. We sought to evaluate the outcome of joint debridement and metatarsal remodeling for the treatment of advanced-stage Freiberg's infraction. Between March 1, 2006, and April 30, 2011, 14 patients (eight females and six males) with symptomatic unilateral Freiberg's disease refractory to conservative treatment (Smillie stages IV and V) underwent joint debridement with metatarsal head remodeling by two surgeons. To evaluate functional outcome, American Orthopaedic Foot and Ankle Society and 36-Item Short Form Health Survey forms were completed by the patients preoperatively and postoperatively at months 3, 6, and 12. Active-assisted range-of-motion exercise was allowed after 4 weeks of short-leg walking cast wear, and weightbearing on the forefoot was allowed as tolerated. Mean patient age was 27.0 years (range, 16-53 years), and mean follow-up was 40.2 months (range, 14-54 months). Mean ± SD American Orthopaedic Foot and Ankle Society and 36-Item Short Form Health Survey scores were 46.8 ± 8.95 and 28.9 ± 4.3 preoperatively and 76.2 ± 9.5 and 45.6 ± 7.7 1 year after surgery, respectively. There was a significant increase in both scores (P ≤ .001). In advanced-stage Freiberg's infraction of the second metatarsal, joint debridement and metatarsal head remodeling is a safe and simple therapeutic option, and it provides better quality of life for patients.