Table 2.

Pearls and Pitfalls of Arthroscopic Dorsal Closing-Wedge Osteotomy of Metatarsal Head for Management of Freiberg Infraction

Pearls

The surgeon sits at the end of the operating table, allowing a more logical arthroscopic orientation and ergonomic hand motion during the osteotomy procedure.

The inclination of the bone wedge should be adjusted according to the presence of associated metatarsal anomalies.

The orientation of resection of the lateral half of the bone wedge should be the same as the resection of the medial half of the bone wedge.

The edges of the metatarsal are regularly “probed” with the burr to determine the depth of bone resection.

Pitfalls

The osteotomy will be unstable if the plantar cortical hinge is broken.

The osteotomy cannot be closed up if the orientation of bone cut at the medial and lateral halves of the osteotomy is different.