Successful treatment of advanced Freiberg’s disease with a modified Weil osteotomy, 5-year follow up: A Pilot case series with a review of the literature

Abstract

IntroductionTreatment for Freiberg’s disease is largely conservative. For severe disease and refractory cases, there are various surgical options. The purpose of this study was to report the 5-year clinical outcomes of a modified Weil osteotomy in the treatment of advanced Freiberg's disease. MethodsTwelve patients (12 feet), with a mean age of 30.7 years (range 17–55), were treated with synovectomy and modified Weil osteotomy of the affected distal metatarsal head. There were 10 females and 2 males. Clinical outcomes were independently evaluated pre and postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and a subjective satisfaction score. Radiological union was evaluated postoperatively. Nine (75%) feet involved the 2nd metatarsal and 3 feet (25%) involved the 3rd metatarsal. According to the Smillie classification, 6 feet were Grade IV and 6 feet were grade V. ResultsNo patients were lost to follow up and the mean follow-up time was 5.2 years (4−7). AOFAS scores improved from 48.1 + /- 7.4–88.9 + /- 10.1 postoperatively giving a mean improvement of 40.8 (p < 0.001). In total, 92% of patients were satisfied with their operation at latest follow-up, reporting excellent or good results. All patients had postoperative radiological union. One patient had a superficial postoperative infection that was successfully treated with oral antibiotics. ConclusionModified Weil osteotomy is an effective treatment for advanced Freiberg's disease with good outcomes and few complications.