A comperative study between two different surgical techniques in the treatment of late-stage Freiberg's disease

Surgical Management of Freiberg’s Infraction

“…A total of 59 (18.0%) postoperative complications occurred: continued pain (30), joint stiffness (9), floating toe (5), transfer lesion (3), weak dorsiflexion of the toe (2), hyperthesia over the surgical (2), hardware irritation (2), broken hardware (1), stress fracture after removal of external fixation pins (1), superficial infection (1), sinus tract (1), transfer metatarsalgia (1), delayed union (1), and development of a Morton's neuroma (1). 15,31,33,36,45,55,59,62,64,65,68,[71][72][73] Of these complications, 28 (2.1%) did not cause pain, had resolution of pain, or improved: no pain with joint stiffness (7), no pain with floating toe (5), no pain with transfer lesion (3), weakness with dorsiflexion of the second toe improved (2), hyperthesia over the surgical scar improved (2), pain resolution with conversion of a previous Smillie procedure to implant arthroplasty (1), Morton's neuroma resolved with neurectomy (1), hardware irritation resolved with removal (1), no pain with broken hardware (1), complete union of delayed union (1), complete union of stress fractures from external fixation pin sites (1), no pain with transfer metatarsalgia (1), resolution of superficial infection (1), resolution of sinus tract with hardware removal (1). 55,59,65,71 The most common unresolved postoperative complication was continued pain.…”

Arthroscopic Interpositional Arthroplasty of the Second Metatarsophalangeal Joint

“…23 Nowadays, the use of a silicone implant is not recommended for the management of second MTP degenerative disease in active adults. 22,23 Furthermore, the evidence in published studies is insufficient to support the use of metallic or ceramic materials. 22,23 A number of authors have reported information on the success of dorsal wedge osteotomies.…”

“…22,23 Furthermore, the evidence in published studies is insufficient to support the use of metallic or ceramic materials. 22,23 A number of authors have reported information on the success of dorsal wedge osteotomies. However, there are no long-term results to identify transfer metatarsalgia.…”

“…22 Moreover, excessive dissection and/or poor fixation technique can cause major problems such as infection, soft-tissue irritation, malunion, nonunion, aseptic necrosis, and metacarpal shortening. 22,23 El-Tayeby 26 reported an interpositional arthroplasty for Freiberg disease. The tendon of the extensor digitorum longus is used for surfacing and as a spacer.…”

“…[2][3][4][5][6][7][8][14][15][16][17][18][19][20][21][22][23][24] Excision of the metatarsal head is not recommended because of the risk of shortening of the toe, a break in the alignment of the metatarsal arch and transfer metatarsalgia, instability of the MTP joint and deformity of the toes, hallux valgus, and gait disturbance. 22,25 Joint replacement arthroplasty has been used in the advanced stages of the disease. 17 In patients with high levels of physical activity, such as active adolescents, silicone or hemiarthroplasty implants can result in several problems, including inappropriate fit, poor material strength, implant loosening, local bony resorption, a lack of toe purchase, infection, hardware irritation, and transfer metatarsalgia.…”