How is Surgery Performed?

Freiberg’s disease can result in pain from a joint. To treat the pain, the joint surfaces must be moved further apart, so that scar tissue can be formed between the surfaces, or the damaged surface is replaced with undamaged cartilage tissue from elsewhere.

There are several options for surgery - shortening the metatarsal bone to increase the space, taking away the end of the metatarsal bone completely, or replacing the damaged joint surface with cartilage tissue from the knee.

The shortening operation is usually successful, but occasionally there is recurrent pain after surgery, especially if the toe bones retract to allow bony contact again. If the end of the metatarsal is removed, then the toe can shorten, giving a strange appearance to the toes, but it should be pain free.

Replacing the cartilage requires an operation on the knee to take cartilage tissue from an area not involved in a joint. This can have risks of it’s own, and is not my usual practice as good results can be achieved by the other types of surgery.

Surgery is carried out under general anaesthetic, but can be carried out with local anaesthetic injections behind the knee or around the ankle. The injections are normally given while you are asleep for your comfort. They can give good pain relief for the first day after the operation. You can go home the same day in the evening.

Risks of Surgery

Bleeding, infection, poor bone healing, poor skin healing, injury to tendons, injury to nerves, recurrence, and a need for further surgery.

There is a small risk of blood clots in the legs or lungs (DVT and PE), and there are also risks from anaesthesia - the process of being put to sleep for your operation.

Risks of Anaesthesia

The injection behind your knee is given using an ultrasound machine to guide the needle. There is a less than 1% chance of injury to the nerve. General anaesthetic also carries risks. These risks are proportional to your general health. You will need to be assessed for your fitness for surgery and an Anaesthetist will be able to advise you on your individual risk.

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