Late-Stage Freiberg's Disease Treated with Dorsal Wedge Osteotomy and Joint Distraction Arthroplasty: Technique Tip

Freiberg’s disease is an osteochondral infraction of the second or third metatarsal head causing swelling, stiffness, and pain of the metatarsophalangeal (MTP) joint. In the early stages of Freiberg’s disease, such as stages I and II of Smillie’s classification,7 nonoperative therapy is considered the recommended treatment, whereas operative interventions are usually reserved for stages III, IV, and V. Dorsal wedge or dorsiflexion osteotomy, first introduced by Gauthier and Elbaz,3 has produced satisfactory results. Classically, the operation includes removal of the necrotic portion through a dorsal closing-wedge osteotomy, rotation of the plantar part of the metatarsal head, and fixation with absorbable sutures, Kirschner wires, or multiple absorbable pins.1,5,6 For late-stage Freiberg’s disease, stages IV and V, however, the lesion is often large and the whole joint is degenerated. These patients are thus prone to delayed union and fail to regain normal range of motion if they only receive dorsal wedge osteotomy.6 Reasons for this may include the secondary injury to the articular surface when placing multiple pins for fixation, postoperative adhesion and contracture of the capsule, and degeneration of the whole joint. This report introduces a modification to the traditional dorsal wedge osteotomy of the involved metatarsal head in