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Closing Wedge Osteotomy for Freiberg Infraction
The Freiberg infraction is the progressive deformation of the articular surface of the metatarsal head. It most commonly occurs in young, female patients. Definitive evidence-based treatments have not been established, so evaluation and treatment methods are largely anecdotal, and treatment must be individualized to each patient. These lesions are variably symptomatic, and radiographic classifications do not reliably correlate with patient symptomatology. Therefore, pain and loss of function are the best indications for intervention. A trial of nonsurgical management is the most prudent initial course of action. Nonsurgical management aims to decrease foot pressure and unload the affected metatarsal. Spontaneous healing may occur at any stage of disease. Surgical treatment should be undertaken after failure of 6 to 12 months of nonsurgical treatment. Lesions with preserved joint space and in which less than 25% of the dorsal metatarsal head is involved are most amenable to dorsal closing wedge osteotomy.