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

• Published in: Foot & ankle international Vol. 37; no. 1; pp. 90 - 95
• Main Authors: Pereira, Bruno S., Frada, Tiago, Freitas, Daniel, Varanda, Pedro, Vieira-Silva, Manuel, Oliva, Xavier Martin, Duarte, Rui M.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-01-2016
• Subjects: Adolescent; Child; Female; Follow-Up Studies; Humans; Male; Metatarsal Bones - diagnostic imaging; Metatarsal Bones - surgery; Metatarsophalangeal Joint - diagnostic imaging; Metatarsophalangeal Joint - surgery; Metatarsus - abnormalities; Metatarsus - diagnostic imaging; Metatarsus - surgery; Osteochondritis - congenital; Osteochondritis - diagnostic imaging; Osteochondritis - surgery; Osteotomy - methods; Patient Satisfaction; Radiography; Retrospective Studies; Freiberg disease; metatarsal heads; dorsal wedge osteotomy; forefoot disorders; Gauthier and Elbaz
• DOI: 10.1177/1071100715598602
• EISSN: 1944-7876
• ISSN: 1071-1007

Background:
Treatment for Freiberg disease has been largely conservative despite availability of various operative options for severe or refractory cases. The aim of this study was to evaluate the long-term results of pediatric patients with symptomatic Freiberg disease treated with intra-articular dorsal wedge osteotomy.
Methods:
Pediatric patients treated for Freiberg disease with surgery between January 1982 and 1999 were identified and selected for long-term clinical evaluation. Patients were evaluated regarding operative satisfaction and clinical outcome, performed according to the American Orthopaedic Foot & Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale and range of motion (ROM) of metatarsophalangeal (MTP) joint. Patients had radiographic assessment of degenerative joint status with anteroposterior and oblique foot x-ray. Twenty patients (18 female, 2 male; mean age 15.2 years; range 12-17 years) were identified. The mean follow-up period was 23.4 (range 15-32) years.
Results:
The clinical outcomes of our patients were classified as excellent in 16 (80%) and good in 4 (20%). The AOFAS mean score was 96.8 (range 91-100) points at the last clinical appointment. A negative correlation between AOFAS score and time of follow-up (r’s = −0.61, P < .001) was found. Also, a strong negative correlation was found between Smillie classification and AOFAS final score (r’s = −0.88, P < .001).
Conclusion:
The patients were very satisfied with pain and quality of life at a mean follow-up time of 23.4 years. To our knowledge, this is the first long-term follow-up report supporting the procedure described by Gauthier and Elbaz as a good option for operative treatment of Freiberg disease.
Level of Evidence:
Level IV, retrospective case series.