1. Metatarsalgia—second ray Case for small group discussion
AOTrauma—Foot & Ankle
Module 15: The lesser toes
Les Grujic, AU

2. Case description 14-year-old girl Dancer Right forefoot pain
Causing increasing trouble
Examination showed thickening around the second metatarsal phalangeal joint
Reduced range of movement particularly dorsiflexion
Pain on movement
Examination otherwise unremarkable

3. Preoperative x-rays Weight bearing x-rays
To describe x-rays abnormalities
Is the bipartite sesamoid a problem?

4. Discussion topics Pathophysiology of the disease Causes of pain
Additional imaging studies
Nonoperative treatment
Surgical treatment options
Freiberg disease

5. Surgical debridement and dorsiflexion osteotomy
Preoperative
Postoperative
How should debridement be performed?
Objectives of debridement

6. Postoperative x-rays
Osteotomy?
What kind?

7. 4 months postoperative

8. Take-home messages
Freiberg disease is an important cause of metatarsalgia in young patients
The plantar aspect of the articular surface is spared
X-rays are diagnostic in advanced stages
Symptoms are relieved with joint debridement and dorsiflexion osteotomies