Surgical interventions of Freiberg's disease: A systematic review

Foot Ankle Surg. 2021 Aug;27(6):606-614. doi: 10.1016/j.fas.2020.08.005. Epub 2020 Aug 27.


Background: Freiberg's disease is an osteonecrosis of the metatarsal head bone. Numerous surgical interventions can be provided; however, the literature is limited in systematic reviews discussing the various options. The study aimed to systematically review the quantity and quality of literatures exploring the surgical interventions.

Methods: Fifty articles were found to be relevant for assessing the efficacy of common surgical interventions. The articles were assigned a level of evidence (I-V) to assess their quality. Next, the studies were reviewed to provide a grade of recommendation (A-C, I).

Results: Two studies were found at level III that explored osteotomy and autologous transplantation; the other studies were level IV-V. There is poor evidence (grade C) in supporting of joint sparing and joint sacrificing for Freiberg's disease.

Conclusion: Poor evidence exists to support the surgical interventions for Freiberg's disease, higher quality trials are needed to support the increasing application of these surgical techniques.

Level of evidence: Level IV, Systematic review.

Keywords: Freiberg disease; Hemiarthroplasty; Interposition arthroplasty; Metatarsal osteotomies; Microfracture; Open joint debridement; Perichondeal grafting; Resection arthroplasty.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Metatarsal Bones* / surgery
  • Metatarsus / abnormalities
  • Osteochondritis* / congenital

Supplementary concepts

  • Freiberg's disease