Clinical Study On The Treatment Of Freiberg's Disease With Closed Wedge Osteotomy

Objective To investigate the incidence of Freiberg's disease and the clinical result of dorsal wedge osteotomy in the treatment of Freiberg's disease.Materials and Methods The data of patients with Freiberg disease treated with closed wedge osteotomy and undergoing regular follow-up were collected from January 2012 to October 2017.There are 7 male patients and 21 female patients in this group.The average age at the time of surgery was 41 years old(from 12 to 69 years).The mean preoperative sustaining period of complaints was 14 months(from 1 month to 10 years).The second metatarsal head was affected in 25 patients,the third in 3 patients.According to the Smillie's classification,9 patients had type?,13 patients had type ?,4 patients had type ?,and 2 patients had type ?.There are three patients combined with hallux valgus,two patients had a history of hallux valgus osteotomy,two patients combined with gout and three patients had a history of trama.The patient's wound healing,osteotomy healing,pain relief,and metatarsophalangeal joint motion and metatarsal length at the final follow-up were recorded.Visual analogscale(VAS)scores,American Orthopedic Foot and Ankle Society(AOFAS)lesser Metartarsophalangeal-Interphalangeal scores,postoperative shorting of the metatarsal length and the passive range of motion of the metatarsophalangeal joint were evaluated at the last follow-up.Results 28 cases were followed up,and the average follow-up period was 30 months(from 3 months to57 months).There was 1 patient appeared delayed healing of incision after surgery,others were healing by first intention.Based on the AOFAS score at the last follow-up,there were 6 feet excellent,14 feet good,5 feet medium and 3 feet poor.And the rate of excellent and good was 71.5%.The mean AOFAS store and VAS store was 77.3±8.7 and 2.2±1.0,which was significantly different compared with preoperative ones(p<0.001).A mean loss of 7.8±4.4°plantar flexion and 3.7±3.5°dorsiflexion was noted.Except for 2 cases of Smillie ? patients with joint stiffness,the remaining patients did not affect the normal gait.The mean postoperative shorting of the metatarsal length was 1.9±0.5mm.Transfer metatarsalgia was not identified in any of the patients.Conclusion 1.The early symptoms of Freiberg's disease are not obvious,and the X-ray is negative.The suspicion patient should be further examined by MRI or the regular review of the clinic 2.Dorsal wedge osteotomy can significantly improve the patient's symptoms,and no server complications,it is more suitable for Smillie ?,? cases.