September 2007 (Volume 2, No.9)

1. Dorsiflexory Wedge Osteotomy to Treat Freiberg’s Infraction of the Second Metatarsal Head: A Case Report   Georgeanne Botek, DPM, FACFAS, Martha Anderson, DPM, George Balis, MD [HTML] 

Abstract:  Freiberg’s infraction is an uncommon diagnosis.  The incidence of this disorder is unknown.  However, it represents the fourth most common intra-articular osteochondrosis.  Treatment is based on supportive measures.  The underlying pathology is still not well understood.  In cases where conservative treatment fails, surgery is indicated to improve the patient symptoms.  A case of Freiberg’s infraction is presented that is treated with joint debridement and dorsiflexory wedge osteotomy of the second metatarsal head.  The procedure is not technically difficult and affords the patient symptomatic relief by rotating the healthy plantar cartilage of the joint dorsally and decompressing the joint surface. 

2. Freiberg’s Infraction of the Second Metatarsal Head with Bioorthologic Repair Using the Nexa Osteocure™ Bone Graft:  A Case Report  Al Kline, DPM [HTML]  

Abstract:  Freiberg’s infraction is a relatively common osteochondrosis of the second metatarsal head.   It appears to affect young women who are active in sports.  Its etiology is thought to be traumatic in nature causing a painful altercation, subchondral disruption and collapse of the articular cartilage.  A case report is presented describing this disorder in a young, female runner.  The use of a bioorthologic bone plug to surgically treat this condition is discussed and presented.  It appears that the use of bioorthologic materials provide a promising alternative to surgical osteotomies.  It has been shown that bioorthologic materials will provide a porous scaffold allowing blood, marrow and progenitor cells to wick into the pores and provide a stable environment for tissue in-growth and cellular development. Between six and twelve months, the polymer is resorbed and replaces the natural hyaline cartilage of the joint surface.