{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:50:48Z","timestamp":1791607848920,"version":"4.3.4"},"reference-count":80,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2015,5,19]],"date-time":"2015-05-19T00:00:00Z","timestamp":1431993600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:p>Avascular necrosis of the second metatarsal head was first described by Freiberg in 1913. Conservative treatment includes nonsteroidal anti-inflammatory medication, reduced activity, padding, orthotics, and immobilization. Should conservative treatment fail, a wide variety of surgical procedures exist; however, the optimal procedure is unknown. This systematic review was undertaken to determine which surgical procedure allows for the best resolution of symptoms and return to activity. Included studies were restricted to articles published in English language peer-reviewed journals that consecutively enrolled patients of all ages, with Freiberg\u2019s infraction of any stage, who underwent operative treatment, and had a mean follow-up of greater than or equal to 12 months duration. Eighty-five publications were identified, of which 38 (44.7%) met all the inclusion criteria. Surgical techniques and outcomes were grouped into joint sparing and joint destructive procedures. A total of 70 joint destructive procedures were performed with a combined mean follow-up time of 15.0 months. A greater than 70% resolution of pain and full return to activity was reported. A total of 257 joint sparing procedures were performed with a combined mean follow-up of 30.4 months. A greater than 90% resolution of pain and full return to activity was reported. Results of this systematic review reveal that the results of joint sparing procedures are reported more often and appear to have a better prognosis for symptom resolution and return to activity. Smillie stage was not consistently reported, making it difficult to determine its effect on procedure selection.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Level of Evidence:<\/jats:bold>\n                    Therapeutic, Level IV: Systematic review of Level IV studies\n                  <\/jats:p>","DOI":"10.1177\/1938640015585966","type":"journal-article","created":{"date-parts":[[2015,5,19]],"date-time":"2015-05-19T23:16:14Z","timestamp":1432077374000},"page":"498-519","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":39,"title":["Surgical Management of Freiberg\u2019s Infraction"],"prefix":"10.1177","volume":"8","author":[{"given":"Valerie L.","family":"Schade","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2015,5,19]]},"reference":[{"key":"e_1_3_1_2_2","first-page":"257","article-title":"The so-called infraction of the second metatarsal bone","volume":"8","author":"Freiberg AH.","year":"1926","unstructured":"Freiberg AH. The so-called infraction of the second metatarsal bone. J Bone Joint Surg. 1926;8:257-261.","journal-title":"J Bone Joint Surg"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1923.02650030013004"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00191084"},{"key":"e_1_3_1_5_2","first-page":"243","article-title":"Etiology of Freiberg\u2019s disease: ? trauma","volume":"27","author":"Walsh HP","year":"1988","unstructured":"Walsh HP, Dorgan JC. Etiology of Freiberg\u2019s disease: ? trauma. J Foot Surg. 1988;27:243-244.","journal-title":"J Foot Surg"},{"key":"e_1_3_1_6_2","first-page":"371","article-title":"Eggshell fracture of head of metatarsal","volume":"61","author":"Skillern PG.","year":"1915","unstructured":"Skillern PG. Eggshell fracture of head of metatarsal. Ann Surg. 1915;61:371-372.","journal-title":"Ann Surg"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0891-8422(23)00397-X"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078700800205"},{"key":"e_1_3_1_9_2","first-page":"705","article-title":"Typical disease of the second metatarso-phalangeal joint","volume":"10","author":"Kohler A.","year":"1923","unstructured":"Kohler A. Typical disease of the second metatarso-phalangeal joint. Am J Roent Rad Ther. 1923;10:705-710.","journal-title":"Am J Roent Rad Ther"},{"key":"e_1_3_1_10_2","first-page":"240","article-title":"Freiberg\u2019s infraction: its sequelae and treatment with ultrasound therapy","volume":"47","author":"Arnold AI.","year":"1957","unstructured":"Arnold AI. Freiberg\u2019s infraction: its sequelae and treatment with ultrasound therapy. J Natl Assoc Chirop. 1957;47:240-241.","journal-title":"J Natl Assoc Chirop"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016922209137202"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200704000-00004"},{"key":"e_1_3_1_13_2","first-page":"191","article-title":"Infraction of the second metatarsal bone","volume":"19","author":"Freiberg AH.","year":"1914","unstructured":"Freiberg AH. Infraction of the second metatarsal bone. Surg Gynecol Obstet. 1914;19:191-193.","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.41B1.154"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2012.12.003"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/003591577406700209"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fcl.2011.08.008"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI-2009-0167"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.3810\/psm.2005.03.65"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(20)31868-X"},{"key":"e_1_3_1_21_2","first-page":"35","article-title":"Surgical treatment of Freiberg\u2019s infraction with the use of total joint replacement arthroplasty","volume":"23","author":"Miller ML","year":"1984","unstructured":"Miller ML, Lenet MD, Sherman M. Surgical treatment of Freiberg\u2019s infraction with the use of total joint replacement arthroplasty. J Foot Surg. 1984;23:35-40.","journal-title":"J Foot Surg"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/1938640013510314"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.7547\/1030185"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2007.04.001"},{"key":"e_1_3_1_25_2","first-page":"363","article-title":"The treatment of K\u00f6hler\u2019s second syndrome by continuous skeletal traction","volume":"16","author":"Morandi A","year":"1990","unstructured":"Morandi A, Prina A, Verdoni F. The treatment of K\u00f6hler\u2019s second syndrome by continuous skeletal traction. Ital J Orthop Traumatol. 1990;16:363-368.","journal-title":"Ital J Orthop Traumatol"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078700800206"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/028418518702800118"},{"key":"e_1_3_1_28_2","first-page":"68","article-title":"Early surgical intervention for Freiberg\u2019s infraction: autogenous epiphysiodesis","volume":"18","author":"Lawton JH","year":"1979","unstructured":"Lawton JH. Early surgical intervention for Freiberg\u2019s infraction: autogenous epiphysiodesis. J Foot Surg. 1979;18:68-71.","journal-title":"J Foot Surg"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-199505000-00006"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2005.02.010"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.7547\/87507315-69-2-131"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1067-2516(98)80007-0"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078901000303"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1947-5-308"},{"key":"e_1_3_1_35_2","first-page":"195","article-title":"Freiberg\u2019s infraction of the second metatarsal head with formation of multiple loose bodies","volume":"28","author":"Scartozzi G","year":"1989","unstructured":"Scartozzi G, Schram A, Janigian J. Freiberg\u2019s infraction of the second metatarsal head with formation of multiple loose bodies. J Foot Surg. 1989;28:195-199.","journal-title":"J Foot Surg"},{"key":"e_1_3_1_36_2","first-page":"249","article-title":"Scintigraphic manifestations of infraction of the second metatarsal (Freiberg\u2019s disease)","volume":"28","author":"Mandell GA","year":"1987","unstructured":"Mandell GA, Harcke HT. Scintigraphic manifestations of infraction of the second metatarsal (Freiberg\u2019s disease). J Nucl Med. 1987;28:249-251.","journal-title":"J Nucl Med"},{"issue":"142","key":"e_1_3_1_37_2","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/00003086-197907000-00015","article-title":"Freiberg\u2019s infraction: a subchondral bone fatigue fracture. A new surgical treatment","author":"Gauthier G","year":"1979","unstructured":"Gauthier G, Elbaz R. Freiberg\u2019s infraction: a subchondral bone fatigue fracture. A new surgical treatment. Clin Orthop Relat Res. 1979;(142):93-95.","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_3_1_38_2","first-page":"580","article-title":"Freiberg\u2019s infraction K\u00f6hler\u2019s second disease","volume":"39","author":"Smillie IS.","year":"1957","unstructured":"Smillie IS. Freiberg\u2019s infraction K\u00f6hler\u2019s second disease. J Bone Joint Surg. 1957;39-B:580.","journal-title":"J Bone Joint Surg"},{"key":"e_1_3_1_39_2","first-page":"444","article-title":"Assessment of etiologic factors in the development of Freiberg\u2019s disease","volume":"29","author":"Stanley D","year":"1990","unstructured":"Stanley D, Betts RP, Rowley DI, Smith TW. Assessment of etiologic factors in the development of Freiberg\u2019s disease. J Foot Surg. 1990;29:444-447.","journal-title":"J Foot Surg"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.3928\/0147-7447-19880501-13"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2009.12.001"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.7547\/87507315-72-3-130"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.4055\/cios.2012.4.4.300"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.3928\/0147-7447-19870101-15"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.7547\/1010335"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453679909000985"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2007.03.008"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.7547\/87507315-90-2-77"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078300300512"},{"key":"e_1_3_1_50_2","first-page":"658","article-title":"Freiberg\u2019s infraction: is it more common today?","volume":"51","author":"Feder HJ.","year":"1961","unstructured":"Feder HJ. Freiberg\u2019s infraction: is it more common today? J Am Podiatry Assoc. 1961;51:658-660.","journal-title":"J Am Podiatry Assoc"},{"key":"e_1_3_1_51_2","first-page":"595","article-title":"Freiberg\u2019s infraction as initiating factor of secondary arthritis in the foot","volume":"47","author":"Cinzio JR.","year":"1957","unstructured":"Cinzio JR. Freiberg\u2019s infraction as initiating factor of secondary arthritis in the foot. J Natl Assoc Chirop. 1957;47:595-600.","journal-title":"J Natl Assoc Chirop"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078800900104"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.7547\/87507315-66-3-165"},{"key":"e_1_3_1_54_2","doi-asserted-by":"publisher","DOI":"10.1177\/003591576706000117"},{"key":"e_1_3_1_55_2","doi-asserted-by":"publisher","DOI":"10.3928\/0147-7447-19951201-11"},{"key":"e_1_3_1_56_2","first-page":"234","article-title":"A comparative study between two different surgical techniques in the treatment of late-stage Freiberg\u2019s disease","volume":"19","author":"Kilic A","year":"2013","unstructured":"Kilic A, Cepni KS, Aybar A, Polat H, May C, Parmaksizoglu AS. A comparative study between two different surgical techniques in the treatment of late-stage Freiberg\u2019s disease. The Foot. 2013;19:234-238.","journal-title":"The Foot"},{"key":"e_1_3_1_57_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2012.1015"},{"key":"e_1_3_1_58_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511420075"},{"key":"e_1_3_1_59_2","doi-asserted-by":"publisher","DOI":"10.1177\/1089313X1001400105"},{"key":"e_1_3_1_60_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2008.08.013"},{"key":"e_1_3_1_61_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2008.0950"},{"key":"e_1_3_1_62_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-007-0381-0"},{"key":"e_1_3_1_63_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI-2008-0488"},{"key":"e_1_3_1_64_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-006-0189-4"},{"key":"e_1_3_1_65_2","first-page":"136","article-title":"Dorsal closing-wedge osteotomy in the treatment of Freiberg\u2019s disease","volume":"41","author":"Capar B","year":"2007","unstructured":"Capar B, Kutluay E, M\u00fcjde S. Dorsal closing-wedge osteotomy in the treatment of Freiberg\u2019s disease. Acta Orthop Traumatol Turc. 2007;41:136-139.","journal-title":"Acta Orthop Traumatol Turc"},{"key":"e_1_3_1_66_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2007.0008"},{"key":"e_1_3_1_67_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1607-551X(09)70356-0"},{"key":"e_1_3_1_68_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2004.04.044"},{"key":"e_1_3_1_69_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0958-2592(03)00030-0"},{"key":"e_1_3_1_70_2","doi-asserted-by":"publisher","DOI":"10.1053\/jars.2002.32865"},{"key":"e_1_3_1_71_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659302100309"},{"key":"e_1_3_1_72_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.73B5.1894683"},{"key":"e_1_3_1_73_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.73B1.1991746"},{"key":"e_1_3_1_74_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078900900504"},{"key":"e_1_3_1_75_2","first-page":"159","article-title":"Lesser metatarsophalangeal joint implants","volume":"26","author":"Fox IM","year":"1987","unstructured":"Fox IM, Pro AL. Lesser metatarsophalangeal joint implants. J Foot Surg. 1987;26:159-163.","journal-title":"J Foot Surg"},{"key":"e_1_3_1_76_2","doi-asserted-by":"publisher","DOI":"10.7547\/87507315-75-2-104"},{"key":"e_1_3_1_77_2","doi-asserted-by":"publisher","DOI":"10.7547\/87507315-69-9-556"},{"key":"e_1_3_1_78_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070302400108"},{"key":"e_1_3_1_79_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-197708000-00032"},{"key":"e_1_3_1_80_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070602701202"},{"key":"e_1_3_1_81_2","doi-asserted-by":"publisher","DOI":"10.1097\/RHU.0b013e31821d0894"}],"container-title":["Foot &amp; Ankle Specialist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1938640015585966","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1938640015585966","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1938640015585966","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T21:33:01Z","timestamp":1777411981000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1938640015585966"}},"subtitle":["A Systematic Review"],"short-title":[],"issued":{"date-parts":[[2015,5,19]]},"references-count":80,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2015,12]]}},"alternative-id":["10.1177\/1938640015585966"],"URL":"https:\/\/doi.org\/10.1177\/1938640015585966","relation":{},"ISSN":["1938-6400","1938-7636"],"issn-type":[{"value":"1938-6400","type":"print"},{"value":"1938-7636","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5,19]]}}}