LONG-TERM OUTCOME OF TREATMENT OF METATARSAL HEAD NECROSIS (FRIEBERG DISEASE) USING GAUTHIER OSTEOTOMY

Purpose: Osteonecrosis of the metatarsal heads is a source of metatarsalgia usually triggered by local overload. The Gauthier technique, described in 1974 consists in a dorsal flexion osteotomy with cuneiform resection of the necrotic zone. Results reported in the literature have generally been limited to mid-term. We evaluated the long-term outcome.Material and methods: We conducted a clinical and radiological review of a small homogeneous series of ten patients (nine women and one man) who presented metatarsal head necrosis (generally the third metatarsal) causing mechanical pain. In one patient, the phalangeal surface was degenerative. Eight patients had associated asymptomatic hallux valgus which was left intact. Mean follow-up was 9.5 years (27 months – 19 years).Results: The metatarsophalangeal joint was pain free in all patients. Mean plantar flexion was 25°, extension was free with no particular limitation. Radiographically, there was no evidence of recurrent osteochondritis nor long-term degenera...