title: Results of two different surgical techniques in the treatment of advanced-stage Freiberg's disease.
abstract: BACKGROUND
  Freiberg's disease is an osteochondrosis most commonly seen in adolescent women and characterized by pain, swelling and motion restriction in the second metatarsal. The early stages of this disease can be managed with semirigid orthoses, metatarsal bars and short leg walking cast. Number of operative methods are suggested which can be used depending on the pathophysiology of the disease, including abnormal biomechanics, joint congruence and degenerative process. We evaluated the outcomes of the patients with Freiberg's disease who were treated with dorsal closing-wedge osteotomy and resection of the metatarsal head.
  
  
  METHODS
  16 patients (11 female, 5 male) with a mean age of 24.5 (range 13-49 years) years who underwent dorsal closing wedge osteotomy or resection of the metatarsal head were included in this retrospective study. Second metatarsal was affected in 13 and third metatarsal in three patients. According to the Smillie's classification system, ten patients had type IV osteonecrosis and six patients had type V. The results of the patients were evaluated using the lesser metatarsophalangeal-interphalangeal (LMPI) scale.
  
  
  RESULTS
  According to the LMPI scale, the postoperative scores for the osteotomy and excision groups were 86 (range 64-100) and 72.6 (range 60-85), respectively. In the osteotomy group, mean passive flexion restriction was 18° (range 0°-35°) and mean passive extension restriction was 12° (range 0°-25°). Mean metatarsal shortening was 2.2 mm (range 2-4 mm) in the osteotomy group as opposed to 9.8 mm (range 7-14 mm) in the excision group. Significant pain relief was obtained in both groups following the surgery.
  
  
  CONCLUSIONS
  The decision of performing osteotomy or resection arthroplasty in the patients with advanced-stage Freiberg's disease should be based on the joint injury and the patients should be informed about the cosmetic problems like shortening which may arise from resection.
authors.affiliation: Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakir, Turkey.
authors.forename: Emin
authors.initials: E
authors.lastname: Özkul
authors.affiliation: Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakir, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gem
authors.affiliation: Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakir, Turkey.
authors.forename: Celil
authors.initials: C
authors.lastname: Alemdar
authors.affiliation: Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakir, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Arslan
authors.affiliation: Department of Diyarbakir Training and Educational Hospital, Diyarbakir, Turkey.
authors.forename: Ferit
authors.initials: F
authors.lastname: Boğatekin
authors.affiliation: Department of Diyarbakir Training and Educational Hospital, Diyarbakir, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Kişin
keywords: Freiberg's disease; Metatarsal; Osteonecrosis; arthroplasty; dorsal closing-wedge osteotomy; metatarsal; metatarsus; osteochondrosis; osteotomy; resection