Interpositional Arthroplasty with Extensor Digitorum Brevis Tendon in Freiberg's Disease: A New Surgical Technique

Abstract

We recommend our technique of interpositional arthroplasty with the extensor digitorum brevis tendon because it is free of additional donor site morbidity. It can be performed easily without specialized instruments. Also, the use of natural tissue eliminates potential foreign body reactions and risk of infection.

Long-term Follow-up of Dorsal Wedge Osteotomy for Pediatric Freiberg Disease

“…An operative approach should be reserved for stages III, IV, and V. 7,14,22 Despite the advent of new operative techniques, such as osteochondral plug transfer, arthroplasty or arthroscopic treatment, the ideal method to treat Freiberg disease remains unanswered. 5,6,11,14,16,18,19,21 Dorsal closing-wedge osteotomy was first described by Gauthier and Elbaz in 1979 providing good results in 52 out of 53 patients. 9 After the first description of this operative technique, many authors reported clinical data supporting the success of dorsal wedge osteotomies.…”

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

“…While some early stage lesions may resolve using these conventional procedures, patients who do not respond may require complex surgeries such as core decompression, dorsiflexion osteotomy, osteochondral plug transplantation and arthroplasties, as may patients with stage IV and stage V lesions [8][9][10][11][12][13][14][15][16][17]20]. Historically, the metatarsal head resection with/ without sindactilization was proposed, however, it has additional problems such as hallux valgus, transverse metatarsalgia, shortening of the toe.…”

“…The second comprises procedures that restore articular congruity or address the degenerative features encountered in the later stages of the disease. These include debridement, osteotomy, grafting, and arthroplasty [8][9][10][11][12][13][14][15][16][17]. By reason of multi variety of treatment modalities, leads to uncertainties in predicting the choice of method and results when combining the low incidence of the disease.…”

A simple surgical technique for treatment of Freiberg's disease

“…There are many operative techniques; to treat Freiberg's disease, which include: (1) resection of the metatarsal head, (2) elevation of the depressed fragment of the metatarsal head and bone grafting of the defect, (3) resection of the base of the proximal phalanx with syndactylization of the second and third toes, (4) joint debridement and metatarsal head remodeling, (5) arthroplasty, (6) metatarsal neck shortening osteotomy, without exposing the joint and the osteotomy was fixed with a mini fragment T-plate, (7) osteo-articular transfers, or what are commonly called OATS (Osteochondral Autogenous Transfer System) procedures and (8) dorsal closing wedge osteotomy of the metatarsal head [1,3,[6][7][8].…”

“…This is the bony 'knuckle' in the ball of the foot behind the 2nd toe. The term is also used when the 3rd or 4th metatarsal bones are affected, though these are much less common [1].…”