Abstract

Introduction Freiberg's infarction poses a challenge to foot and ankle surgeons. Several surgical and non surgical treatment methods are described. We performed a dorsal closing wedge osteotomy, debridement and microfracture of the metatarsal head. Dorsal closing wedge osteotomy helps in bringing the smooth plantar articular surface of the metatarsal head to articulate with the phalangeal articular cartilage whilst offloading the damaged dorsal articular cartilage. Debridement and Microfracture of the metatarsal head helps in regeneration of the damaged cartilaage via subchondral stem cells.

Materials and Methods Total of 15 patients (12F, 3M) underwent the above surgery between year 2002 and 2008. Mean age was 35yrs (range14-60). All of them had an extraarticular dorsal closing wedge osteotomy fixed with a single screw along with debridement of the joint and mocrofracture of the damaged cartilage. Post operatively heel weight bearing was allowed with a special shoe for 6 weeks. Serial radiological assessments were done to assess healing of the osteotomy and reshaping of metatarsal head. Patients had a mean follow up of 2.5 yrs (Range 1-6). All patients were assessed using subjective patient satisfaction scores (scale 0-10) and AOFAS scores.

Results 2nd metatarsal was involved in 14 and 3rd in one patient. All the osteotomies healed at a mean period of 10 weeks (range6-18). The mean patient satisfaction score was 8 (range5-10). The mean pre and post operative AOFAS scores were 54 and 82. One patient developed post operative haematoma which resolved spontaneously. No other complications noted

Conclusions A combination of dorsal closing wedge osteotomy, debridement and microfracture is a simple, reproducible and effective method of treating Freiberg's disease with no major complications