Clin Orthop Surg.  2012 Dec;4(4):300-306. 10.4055/cios.2012.4.4.300.

Modified Weil Osteotomy for the Treatment of Freiberg's Disease

• Kim J
• Choi WJ
• Park YJ
• Lee JW

• KMID: 1719298
• DOI: http://doi.org/10.4055/cios.2012.4.4.300

Abstract

BACKGROUND
Numerous metatarsal osteotomies have been developed for the treatment of Freiberg's disease. The purpose of this study was to evaluate the clinical outcomes of modified Weil osteotomy in the treatment of Freiberg's disease.
METHODS
From November 2001 to July 2008, nineteen patients (twenty feet), treated surgically for Freiberg's disease, were included in this study. The average age of the patients was 33.6 years (range, 17 to 62 years), the mean follow-up period was 71.6 months (range, 41 to 121 months). Clinical outcomes were evaluated according to visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the patients' subjective satisfaction and range of motion (ROM) of metatarsophalangeal (MTP) joint. In the radiologic evaluation, initial metatarsal shortening by Freiberg's disease compared to opposite site, metatarsal shortening after modified Weil osteotomy compared with preoperative radiography and term for radiologic union were observed.
RESULTS
VAS showed improvement from 6.2 +/- 1.4 to 1.4 +/- 1.5 at last follow-up (p < 0.0001). Points of AOFAS score increased from 63.3 +/- 14.9 to 80.4 +/- 5.6 (p < 0.0001). ROM of MTP joints also improved from 31.3 +/- 10.1 to 48.3 +/- 13.0 degrees at last follow-up (p < 0.0001). According to Smillie's classification system, there was no significant improvement of VAS, AOFAS score and ROM between early stages (stage I, II, and III) and late stages (stage IV and V). Out of twenty cases, nineteen (95%) were satisfied, reporting excellent or good results.
CONCLUSIONS
Modified Weil osteotomy is believed to be a useful method for the treatment of Freiberg's disease, not only in the early stages but also in the late stages. It relieves pain and improves function via shortening of metatarsals and restoration of MTP joint congruency.

Keyword

Freiberg's disease; Modified Weil osteotomy; Dorsal closing wedge osteotomy

MeSH Terms

Adolescent
Adult
Female
Humans
Male
Metatarsal Bones/pathology/radiography/surgery
Metatarsus/abnormalities/pathology/radiography/surgery
Middle Aged
Osteochondritis/*congenital/pathology/radiography/surgery
Osteotomy/*methods
Pain Measurement
Range of Motion, Articular
Statistics, Nonparametric
Treatment Outcome

Figure

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  Fig. 1 Surgical technique of modified Weil osteotomy in metatarsal.

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  Fig. 2 A 22-year-old woman with Freiberg's disease (case 16) that was classified as Smillie stage II. (A, B) Preoperative radiography shows that central portion begins to sink into the head, altering the contour of the articular surface. (C, D) Through dorsal closing wedge osteotomy with a screw fixation, the metatarsal was shortened and the plantar part of the metatarsal head was rotated. (E, F) Four weeks later after operation, the bridging trabeculae across the osteotomy site emerged which is considered as radiographic union.

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  Fig. 3 The preoperative and postoperative outcomes were compared between early and late stages according to Smillie's classification system. Significant differences of preoperative and postoperative comparison between early and late stages are shown with their p-values. (A) Visual analogue scale (VAS), (B) American Orthopaedic Foot and Ankle Society lesser metatarsophalangeal-interphalangeal scale (AOFAS), (C) range of motion.

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