Frieberg Disease - Surgical Options

What surgical options are available for Frieberg disease?

Two common options are available surgically for this condition. Deciding on these options depends on how advanced the condition is.

Osteotomy (Gauthier):

This is undertaken relatively early in the condition. The unaffected part of the metatarsal head is realigned such that the good quality cartilage in the metatarsal head which is usually in the lower part of the head forms part of the joint.

Cheilectomy:

Here the bony spur which forms later on in the disease will be shaved off. This helps to ease the pain and also improve movement of the affected toe joint.

Type of procedure

This is a day case procedure and same day discharge is usual.

Type of anaesthesia

The operation will be undertaken under a general anaesthetic supplemented with an injection around the ankle to numb the foot (nerve block). The effect of this block will last for a few hours after surgery.

How long will the surgery take?

The surgery normally takes 20 to 30 minutes.

Risks of surgery:

Any orthopaedic surgery carries some inherent risks and it is the surgeons responsibility to fully inform you regarding the benefits and risks of this procedure. Mr Shariff will go through this in detail with you, to help you make an informed decision. This is a fairly routine procedure with risk of:

Infection:

If this occurs it is usually a superficial infection around the wound site.It settles with a course of oral antibiotics. Deep infection is extremely rare. Overall risk is 1%.

Pins & needles or patch of numbness:

Small nerve branches which supply sensation to the skin may be bruised or cut when the skin incision is made. This may cause pins and needles or a patch of numbness around the scar. This feeling generally resolves within a few weeks to a couple of months. Overall risk is 5%.

Persistent symptoms:

Pain and stiffness might persist particularly if the joint has become arthritic.

Recovery from surgery

What can I expect immediately after the surgery whilst in hospital?

When you wake up, it is normal to have numbness in the operated foot as the anaesthetic block will take a few hours to wear off. You will have a bulky dressing to your foot and pins sticking out of the toe.A stiff sole shoe will be provided in which you can walk after surgery. The physiotherapists will make sure that you are safe on your feet before discharge. You will also be given painkillers to take home. It is normal to experience moderate pain after surgery and you can keep this to a minimum by taking regular painkillers.

Specific recovery protocol:

Day 1 - 7

  • Ensure that you keep your foot elevated on pillows to help reduce swelling.
  • Foot wrapped in bulky bandage and surgical stiff sole shoe
  • Allowed to walk in a stiff sole shoe.
  • Ice, elevate, take pain medication
  • Expect numbness in foot 12-24 hours then moderate pain
  • Bloody drainage through bandage expected.
  • Do not change bandage.

Day 14

  • You will have a follow up visit in clinic.
  • You will have an Xray on arrival prior to seeing Mr Shariff
  • Your wound will be inspected. You will have absorbable sutures so they will not need to be removed.
  • Physiotherapy will be commenced as soon as the wound is healed to prevent stiffness.
  • Can get into normal shoes at this stage if a ‘cheilectomy’ has been done.

6 weeks

  • You can expect swelling to last for about 4 months, but you will notice that it gradually starts to settle.
  • You will have started to wear normal foot wear by this time, if an ‘osteotomy’ has been done.

Post operative clinic visit schedule

  • 2 weeks after surgery - wound check and advice regarding basic hygiene
  • 6 weeks after surgery - X-rays and advice regarding exercise
  • 3 months after surgery - final follow up clinical exam and discharge


When can I begin to walk?

You are allowed to walk in a stiff sole surgical shoe on the day of surgery. However you must ensure that you use this shoe at all times for the first 6 weeks after your operation as this provides the necessary support while your bone heals.

0 - 6 weeks - stiff sole surgical shoe (particularly if an ‘osteotomy’ has been done)

After 6 weeks - normal shoes

How do I look after my surgical wound site?

Your wound should be healed 2 weeks after surgery. If you notice any redness around the wound site, get in touch with your consultant as you may have a wound infection. Do not pick on any scabs and allow them to fall off. You will be taught some massage techniques to lighten your scar.

How do I shower or wash?

Do not get your wound wet until it heals completely. You can use a waterproof cover or plastic bag over your foot when you have a shower. Only expose your wound to water after it has healed completely.

When can I get back to driving?

It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times. As a general rule, you are ready to drive when you are able to perform an emergency braking manoeuver without pain. This usually is 2 to 6 weeks after surgery, depending on which type of procedure has been performed. Click here to read the guidance from the DVLA on driving after surgery.

When can I get back to work?

Returning to work is very much dependent on the specific type of job and individual.
As a rule of thumb -

• Office based sedentary work - 2 weeks
• Manual labour - 6 - 8 weeks

When can I get back to sport?

It depends on the kind of exercise, but as a general rule of thumb you can get back to sports like golf 6 weeks after surgery. For high intensity sport, this may take 3 months.

 
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