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

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

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

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

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

Postoperative x-rays Osteotomy? What kind?

4 months postoperative

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