Clinical and radiographic outcomes of dorsal closing wedge osteotomy for Freiberg disease: a retrospective case series

Background Freiberg disease is an uncommon osteonecrotic condition of the metatarsal head that may cause forefoot pain, metatarsophalangeal joint stiffness, and functional limitation.Purpose To evaluate the clinical and radiographic outcomes of dorsal closing wedge osteotomy for Freiberg disease.Study design Retrospective case series; Level IV.Methods Twenty-two patients were retrospectively evaluated. First metatarsal length (D1), second metatarsal length (D2), intermetatarsal angle (IMA), and American Orthopaedic Foot & Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scores were compared between preoperative assessment and final follow-up. Interobserver reliability of radiographic measurements was assessed with intraclass correlation coefficients.Results The mean age was 29.6 ± 13.5 years, and the mean follow-up was 41.8 ± 7.5 months. D1 showed no statistically significant change (58.3 ± 3.7 vs. 57.5 ± 3.9 mm; p = 0.180). D2 decreased significantly (65.8 ± 3.8 vs. 63.4 ± 4.3 mm; mean change, -2.4 mm; p Conclusions Dorsal closing wedge osteotomy was associated with significant improvement in AOFAS scores and significant shortening of the second metatarsal, while D1 and IMA showed no statistically significant change. These findings describe the observed clinical and radiographic outcomes but do not establish a causal relationship between the magnitude of shortening and clinical improvement.