Weil and Dorsal Closing Wedge Osteotomy for Freiberg's Disease

Abstract

Weil and dorsal closing wedge osteotomy of the metatarsal seems to be effective for treating Freiberg's disease. It improves pain and function in terms of shortening the metatarsal length and restoring the metatarsophalangeal joint.

Freiberg's Infraction in a Geriatric Patient - A Case Report

“…In 2016, Lee, et al recommends a combined Weil and closing wedge osteotomy which gave a group of 15 patients increased range of motion, and improved metatarsal length. Lee, et al appears against dorsiflexory wedge osteotomies as he states that the fixation needs to be removed [15]. I normally don't penetrate the distal cortex with my screw across osteotomy and never needed to remove any fixation in this procedure.…”

Functional Outcomes of Local Pedicle Graft Interpositional Arthroplasty in Adults With Severe Freiberg’s Disease

“…11 Lee and coworkers reported significant improvements in postoperative VAS and AOFAS scores among patients undergoing Weil and Dorsal closing wedge osteotomy for Freiberg's disease of the second metatarsal head. 15 In the later stages of this disease process (stage IV and V), it is difficult to restore joint congruity, and therefore joint arthroplasty has been recommended. 29 Despite the various operative treatments described in the literature, no true consensus has been reached with respect to the most optimal surgical management.…”

“…9,27 Even in these early stages, most authors have focused on osteotomy surgery, rotating the metatarsal head dorsally in order to take the dorsal diseased head out of the central arc of motion and instead bringing the plantar cartilage, which is generally intact, into this articulation. 11,15 This is a challenging procedure and risks alteration of the normal loading biomechanics of the forefoot. This can be desirable when shortening of the metatarsal is feasible.…”

“…This can be desirable when shortening of the metatarsal is feasible. 15 However, in the later stages of this disease process it can be difficult to restore joint congruity with debridement alone, and no current literature advocates the procedure. Even osteotomy alone may not restore joint congruity especially as the metatarsal head becomes affected more globally, and therefore joint arthroplasty should be considered.…”

Arthroscopic Dorsal Closing-Wedge Osteotomy of Metatarsal Head for Management of Freiberg Infraction

“…These procedures include intra- or extra-articular dorsal closing-wedge osteotomy, osteochondral transplant, metatarsal shortening osteotomy, marrow stimulation, and micronized allograft cartilage matrix 3, 4, 5, 7, 8, 9, 10, 11. Osteotomy improves pain and function in terms of shortening the metatarsal length and restoring the metatarsal head's sphericity and metatarsophalangeal joint congruency 6, 12, 13. In advanced disease, open or arthroscopic salvage procedures including debridement, removal of the loose bodies, synovectomy, drilling of the metatarsal head, distraction arthroplasty, interpositional arthroplasty, and resection arthroplasty have been proposed 2, 5, 14, 15, 16, 17…”