Surgery for Freiberg’s disease

Freiberg's disease is necrosis or death of the head of some of the metatarsal bones of the foot, usually the second bone, which progresses slowly over time. This relatively rare disease most often affects teenagers, but it can occur at any age.

Its appearance can significantly affect the patient's quality of life. Although the causes of its occurrence are not reliably determined, the problem appears to be related to trauma to the foot, interruption of blood flow to the affected bone, or some combination of the two.

However the disease begins, repeated or frequent pressure on the feet worsens the condition, which is often present in young athletes or young women who often wear high heels. The end of the affected metatarsal bone begins to degrade, sometimes breaking into small pieces. Pain usually occurs in the forefoot directly below the affected metatarsal bone. Discomfort is worst while walking and improves somewhat with rest. The front of the foot may be stiff and may swell. The more pronounced the problem, the greater the likelihood that the patient's gait will turn into a limp over time.
There are several different operative techniques for the treatment of Freiberg's disease, and which one will be applied depends on the stage of bone damage, the age of the patient and some other factors.

When is surgery for Freiberg's disease performed?

The operation is performed when conservative methods of treatment, such as immobilization of the feet and taking anti-inflammatory drugs, have proved unsuccessful or insufficient.

How is surgery for Freiberg's disease performed?

Depending on the condition of the disease and the patient, the surgeon will recommend different techniques:

• cheilectomy (removal of bony protrusions) with joint cleaning,
• removal of damaged cartilage,
• joint decompression by metatarsal shortening i
• interposition arthroplasty.

In any case, the operation is usually done under general anesthesia and takes about an hour. Postoperatively, a local anesthetic is usually given to the foot to reduce pain.

Recovery after surgery for Freiberg's disease

Improvement of the functionality of the feet and removal of pain are noted in about 90% of operated patients. It is usually necessary to wear a special shoe for four weeks postoperatively. The speed of return to work depends on the type of work the patient does. If the patient does an office job, the return is expected after two weeks. The return to work that involves movement is expected in about a month. The return to heavy physical work is optimal after 68 weeks. Stitches are removed between 10 and 14 days after surgery. During those first two weeks, it is necessary to avoid walking as much as possible, and rest as much as possible with the foot elevated in order to reduce swelling.
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