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Evaluation of treatment of freiberg disease by debridement and metatarsal head resection

Introduction Freiberg disease is an ischemic form of necrosis of the head of metatarsals, mainly the second; it is less common in the third and fourth. Affection of the head of the first and fifth is rare. Many factors are responsible for Freiberg disease, including stress overloading, microfractures, vascular impairment, and constitutional etiologies. The disease was classified by Smillie into five stages based on the radiological findings. Patients and methods Between December 2011 and June 2018 at the Misr University for Science and Technology hospital, 20 patients with late stages of Freiberg disease, stage IV and V according to Smillie classification, underwent debridement and resection of the affected head. Diagnosis is done by clinical and radiological examination, and all patients were categorized. The age was from 20 to 50 years, with an average of 32.6±8.5 years. The right side was affected in 14 patients, whereas the left side was affected in six patients. According to Smillie classification, nine cases were class IV and 11 cases were class V. All patients were followed up for Kitaoka’s items. Results All patients were improved regarding pain and function, and no cases with severe or constant pain, or limited daily or recreational activities were reported. No cases used especial shoes or brace at the final follow-up. Infection was not reported in this study. The final score improved in all cases from 52±14 (range: 29–69) to 89±7 (range: 80–100). Conclusion Metatarsal head resection after debridement is an effective and easy procedure for treatment of late stages of Freiberg disease with no hardware and allows early weight bearing and fast pain relief.