title: Treatment of Freiberg's disease by Gauthier's dorsal cuneiform osteotomy: Retrospective study of 30 cases.
abstract: BACKGROUND
  Freiberg's disease is osteonecrosis of the dorsal side of a metatarsal head. The gold-standard surgical treatment is the osteotomy procedure first described by Gauthier.
  
  
  OBJECTIVE
  Gauthier osteotomy for Freiberg's disease will restore the joint space and lead to long-term clinical improvement. A retrospective study was carried out to verify this hypothesis.
  
  
  METHODS
  This study involved 30 consecutive cases treated by a single surgeon in 28 patients having a mean age of 61.2 years. These patients underwent the Gauthier osteotomy procedure with one or two dorsal staples used for fixation. Patients were reviewed 15 days, 45 days and 3 months after the procedure, and then at the last follow-up to look for any complications and determine patient satisfaction, the AOFAS score, metatarsophalangeal range of motion (ROM), sphericity of the metatarsal head, bone union and metatarsal shortening.
  
  
  RESULTS
  The average follow-up was 6.5 years ± 2.2. The second metatarsal was affected in 27 cases and the third metatarsal in 3 cases. Discomfort related to the staples was noted in five cases; the staples were removed in three of them. There was one case of severe stiffening (< 20° ROM). At the last follow-up, 17 cases were very satisfied, 11 were satisfied and 2 were moderately satisfied. The average AOFAS score was 83.8 points ± 11.8 at the last follow-up. A mean loss of 15° plantar flexion and 10° dorsiflexion was noted. Bone union and metatarsal head sphericity were achieved in all cases. The average shortening was 2 mm ± 1.4.
  
  
  CONCLUSIONS
  The Gauthier osteotomy procedure results in recovery of the metatarsal head's sphericity in every case of this series, with good clinical results and low morbidity.
authors.affiliation: Centre du pied, 68, rue du Commandant-Rolland, 13008 Marseille, France. Electronic address: mariannehelix@orange.fr.
authors.forename: M
authors.initials: M
authors.lastname: Helix-Giordanino
authors.affiliation: CHU G.-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: E
authors.initials: E
authors.lastname: Randier
authors.affiliation: Hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Frey
authors.affiliation: Centre du pied, 68, rue du Commandant-Rolland, 13008 Marseille, France.
authors.forename: B
authors.initials: B
authors.lastname: Piclet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008684:Metatarsus / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D010007:Osteochondritis / Q000151:congenital* / Q000503:physiopathology / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013997:Time Factors
keywords: Freiberg; Gauthier; Metatarsal osteotomy; Metatarsalgia