Dorsal Metatarsal Closed Wedge Osteotomy in the Treatment of Freiberg’s Disease: A Prospective Observational Study

Abstract

Background

The aim of this study was to prospectively evaluate the clinical and radiological results of dorsal metatarsal closed wedge osteotomy and headless screw fixation in the surgical treatment of Freiberg’s disease.

Methods

Thirty-four patients who were treated with dorsal metatarsal closed wedge osteotomy (DMCWO) for Freiberg’s disease between February 2018 and March 2022 were included in the study. Patients were staged according to the classification system described by Smillie. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society’s (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the visual analog scale (VAS), the range of motion (ROM) of the metatarsophalangeal (MTP) joint, and a subjective patient satisfaction questionnaire. For radiological evaluation, the amount of preoperative shortening of the involved metatarsal, the amount of metatarsal shortening developed after osteotomy, and radiological recovery times were recorded.

Results

Thirty-two (94.1%) of the patients were female, and two (5.9%) were male. The average postoperative follow-up period for patients was 33.7 months (range: 24 months to 41 months). The mean AOFAS scores increased from 53.24 to 86.26 (p < 0.01). The mean VAS scores decreased from 8.59 to 1.79, and it was observed that the patients’ pain improved significantly (p < 0.01). The mean ROM of the MTP joint increased from 48.76 degrees to 70.76 degrees (p < 0.01). An average of 2.5 mm (range 1 mm to 4.1 mm) of shortening of the metatarsal length developed postoperatively (p < 0.01). Arthrosis developed in 1 case (2.9%), and transfer metatarsalgia developed in 2 cases (5.8%).

Conclusions

DMCWO is an effective treatment for both the early and advanced stages of symptomatic Freiberg’s disease, leading to high patient satisfaction.

Zusammenfassung

Einleitung

Ziel der Studie war es, die klinischen und radiologischen Ergebnisse der dorsalen metatarsalen Schließkeilosteotomie und Schraubenfixierung bei der chirurgischen Behandlung der Freiberg-Krankheit prospektiv zu bewerten.

Methoden

34 Patienten, die zwischen Februar 2018 und März 2022 eine dorsale metatarsale Schließkeilosteotomie (DMCWO) bei Freiberg-Krankheit erhielten, wurden in die Studie einbezogen. Die Patienten wurden nach der von Smillie beschriebenen Klassifikation eingestuft. Klinische Ergebnisse wurden mit der American Orthopedic Foot and Ankle Society (AOFAS), Lesser Metatarsophalangeal-interphalangeal Scale, der visuellen Analogskala (VAS), dem Bewegungsumfang (ROM) des Metatarsophalangealgelenks und einer subjektiven Patientenzufriedenheitsbefragung bewertet. Für die radiologische Bewertung wurden die Menge der präoperativen Verkürzung des betroffenen Metatarsals, die Menge der nach der Osteotomie entwickelten Metatarsalverkürzung und die radiologischen Erholungszeiten aufgezeichnet.

Ergebnisse

32 (94,1%) der Patienten waren weiblich und 2 (5,9%) waren männlich. Die durchschnittliche postoperative Nachbeobachtungszeit für die Patienten betrug 33,7 Monate (Bereich 24 Monate bis 41 Monate). Die mittleren AOFAS-Werte stiegen von 53,24 auf 86,26 (p < 0,01). Die mittleren VAS-Werte sanken von 8,59 auf 1,79 und es wurde beobachtet, dass die Schmerzen der Patienten signifikant abnahmen (p < 0,01). Der mittlere ROM des MTP-Gelenks stieg von 48,76° auf 70,76° (p < 0,01). Es entwickelte sich eine durchschnittliche Metatarsalverkürzung von 2,5 mm (Bereich 1–4,1 mm) postoperativ (p < 0,01). Arthrose entwickelte sich in einem Fall (2,9%) und Transfermetatarsalgie entwickelte sich in 2 Fällen (5,8%).

Zusammenfassung

Die DMCWO ist eine wirksame Behandlung sowohl für frühe als auch fortgeschrittene Stadien der symptomatischen Freiberg-Krankheit, die zu hoher Patientenzufriedenheit führt.

Keywords

Freiberg disease - metatarsal osteotomy - metatarsalgia - osteochondrosis

Schlüsselwörter

Freiberg-Krankheit - Metatarsalosteotomie - Metatarsalgie - Osteochondrose

Publication History

Received: 19 February 2024

Accepted after revision: 12 June 2024

Article published online:
02 July 2024

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