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Debridement and Microfracture in the Treatment of Freiberg Disease

Pastides, Philip S. MRCS (Eng), MSc (Orth Eng)*; El-Sallakh, Sameh MS Orth, MCh Orth, MD Orth; Charalambides, Charalambos MD, FRCS (Trauma & Ortho)

Techniques in Foot & Ankle Surgery: September 2012 - Volume 11 - Issue 3 - p 150–154
doi: 10.1097/BTF.0b013e3182650d2f

Freiberg disease is an uncommon condition of anterior metatarsalgia that involves the head of the lesser metatarsals. Several operative techniques such as dorsal wedge osteotomies and insertion of metallic spacers have been used to treat this condition. However at our institution, we perform a technique not previously described, involving microfracture of the metatarsal head and reattachment of the cartilage flap. The mean follow-up period of the 11 patients described was 49 postoperative months (18 to 96 mo). At 6 months, mean visual analog pain score at rest and on mobilizing was 2.1 (0 to 3) and 3.1 (0 to 5), respectively (P<0.05). All 11 patients had reported a satisfactory outcome and return to acceptable activity levels. This operative technique is a safe and feasible treatment option for patients suffering from late-stage Freiberg disease. It is advantageous as it does not cause shortening or other anatomic abnormalities in the area. All of our patients reported a significant reduction of pain in their feet and all were able to walk and run almost pain free. There were no reported cases of severe restriction of movement or fixed deformity of the toe. We conclude that our technique is a successful alternative operative technique for late-stage Freiberg disease.

*The Whittington Hospital

Department of Trauma and Orthopaedics and Foot and Ankle Surgery, London, UK

Department of Orthopaedic Surgery, Tanta University Hospital, Tanta, Egypt

The authors declare no conflict of interest.

Address correspondence and reprint requests to Philip Pastides, MRCS (Eng), MSc (Orth Eng), The Whittington Hospital, Magdala Avenue, London N19 5NF, UK. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.