Surgical interventions of Freiberg's disease: A systematic review

Background Freiberg’s disease is an osteonecrosis of the metatarsal head bone. Numerous surgical interventions can be provided; however, the literature is limited in systematic reviews discussing the various options. The study aimed to systematically review the quantity and quality of literatures exploring the surgical interventions. Methods Fifty articles were found to be relevant for assessing the efficacy of common surgical interventions. The articles were assigned a level of evidence (I–V) to assess their quality. Next, the studies were reviewed to provide a grade of recommendation (A–C, I). Results Two studies were found at level III that explored osteotomy and autologous transplantation; the other studies were level IV–V. There is poor evidence (grade C) in supporting of joint sparing and joint sacrificing for Freiberg’s disease. Conclusion Poor evidence exists to support the surgical interventions for Freiberg’s disease, higher quality trials are needed to support the increasing application of these surgical techniques. Level of Evidence Level IV, Systematic review.