{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:22:23Z","timestamp":1783506143657,"version":"3.55.0"},"reference-count":48,"publisher":"MDPI AG","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The extent of necrosis is the main determining factor in the outcome of osteonecrosis. There is no method for measuring the extent of osteonecrosis of the metatarsal head in Freiberg\u2019s disease. The purpose of this study was to determine the reliability and prognostic ability of a new method for measurement of the extent of osteonecrosis in Freiberg\u2019s disease on three-dimensional computed tomography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective review of 11 cases with symptomatic Freiberg\u2019s disease in ten patients (5 males and 5 females; mean age, 27 years) undergoing computed tomography between July 2005 and September 2007 was performed. Two investigators (K.A.C. and H.K.O.) used a new method to measure the necrotic extent of the metatarsal head: the necrotic angle ratio of necrotic arc angle to normal arc angle of the articular surface on the sagittal reconstruction image of computed tomography. The interobserver reliability was determined for computed tomography measurement. Correlation between the Smillie staging using radiographs and the necrotic angle ratio on computed tomography was also evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>One patient presented with stage I disease (Smillie staging), one with stage II, two with stage III, five with stage IV, and two with stage V, respectively. The necrotic angle ratio of the metatarsal head was 14% in stage I, 21% in stage II, 34% in stage III, 43% in stage IV, and 53% in stage V. The interobserver reliability for computed tomography measurement was high (Cronbach \u03b1=0.96). We found the increase of the necrotic extent in proportion to the Smillie stage. The Smillie staging using radiographs and the necrotic angle ratio on computed tomography were significantly correlated. (P&amp;lt;0.05)<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Three-dimensional computed tomography measurement of the necrotic extent of the metatarsal head is a reliable and useful method in evaluating the staging of Freiberg\u2019s disease and may eventually help to optimize treatment. (J Am Podiatr Med Assoc 101(4): 335\u2013340, 2011)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7547\/1010335","type":"journal-article","created":{"date-parts":[[2014,4,1]],"date-time":"2014-04-01T09:47:59Z","timestamp":1396345679000},"page":"335-340","source":"Crossref","is-referenced-by-count":8,"title":["Freiberg\u2019s Disease"],"prefix":"10.3390","volume":"101","author":[{"given":"Kyung Ah","family":"Chun","sequence":"first","affiliation":[{"name":"Department of Radiology, The Catholic University of Korea, Uijeongbu St. Mary\u2019s Hospital, Uijeongbu-si, Gyeonggi-do, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung Keun","family":"Oh","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Inje University, Ilsanpaik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kook Hyun","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Inje University, Ilsanpaik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Soo","family":"Suh","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Inje University, Ilsanpaik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"ref341","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1053\/j.jfas.2008.08.013","article-title":"Freiberg\u2019s infraction of the second metatarsal treated with autologous osteochondral transplantation and external fixation.","volume":"47","author":"DeVries","year":"2008","journal-title":"J Foot Ankle Surg"},{"key":"ref391","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/S1607-551X(09)70356-0","article-title":"Freiberg\u2019s infraction\u2014treatment with metatarsal neck dorsal closing wedge osteotomy: report of two cases.","volume":"22","author":"Lin","year":"2006","journal-title":"Kaohsiung J Med Sci"},{"key":"ref421","doi-asserted-by":"crossref","first-page":"753","DOI":"10.3928\/0147-7447-19880501-13","article-title":"Freiberg disease complicating unrelated trauma.","volume":"11","author":"Binek","year":"1988","journal-title":"Orthopedics"},{"key":"ref141","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0030-5898(20)31868-X","article-title":"Treatment of Freiberg\u2019s disease.","volume":"25","author":"Katcherian","year":"1994","journal-title":"Orthop Clin North Am"},{"key":"ref381","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0030-5898(20)31868-X","article-title":"Treatment of Freiberg\u2019s disease.","volume":"25","author":"Katcherian","year":"1994","journal-title":"Orthop Clin North Am"},{"key":"ref121","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.3928\/0147-7447-19951201-11","article-title":"Core decompression as a novel treatment for early Freiberg\u2019s infraction of the second metatarsal head.","volume":"18","author":"Freiberg","year":"1995","journal-title":"Orthopedics"},{"key":"ref171","doi-asserted-by":"crossref","first-page":"570","DOI":"10.2214\/AJR.07.2847","article-title":"MRI of metatarsal head subchondral fractures in patients with forefoot pain.","volume":"190","author":"Torriani","year":"2008","journal-title":"AJR Am J Roentgenol"},{"key":"ref281","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1302\/0301-620X.83B5.0830672","article-title":"Volumetric analysis of osteonecrosis of the femur. 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A new surgical treatment.","volume":"142","author":"Gauthier","year":"1979","journal-title":"Clin Orthop Relat Res"},{"key":"ref261","first-page":"29","article-title":"Treatment of Freiberg\u2019s infraction.","volume":"60","author":"Smillie","year":"1967","journal-title":"Proc R Soc Med"},{"key":"ref181","doi-asserted-by":"crossref","first-page":"753","DOI":"10.3928\/0147-7447-19880501-13","article-title":"Freiberg disease complicating unrelated trauma.","volume":"11","author":"Binek","year":"1988","journal-title":"Orthopedics"},{"key":"ref291","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1302\/0301-620X.80B6.0800954","article-title":"Estimation of the extent of osteonecrosis of the femoral head using MRI.","volume":"80","author":"Kim","year":"1998","journal-title":"J Bone Joint Surg Br"},{"key":"ref311","doi-asserted-by":"crossref","first-page":"208","DOI":"10.5435\/00124635-200704000-00004","article-title":"Osteonecrosis in the foot.","volume":"15","author":"DiGiovanni","year":"2007","journal-title":"J Am Acad Orthop Surg"},{"key":"ref361","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.3928\/0147-7447-19951201-11","article-title":"Core decompression as a novel treatment for early Freiberg\u2019s infraction of the second metatarsal head.","volume":"18","author":"Freiberg","year":"1995","journal-title":"Orthopedics"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1302\/0301-620X.83B5.0830672","article-title":"Volumetric analysis of osteonecrosis of the femur. 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Early diagnosis and treatment.","volume":"67","author":"Ficat","year":"1985","journal-title":"J Bone Joint Surg Br"},{"key":"ref01","first-page":"878","article-title":"Freiberg\u2019s infraction.","volume":"30","author":"Peh","year":"2001","journal-title":"Am J Orthop (Belle Mead NJ)"},{"key":"ref211","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/S0749-8063(96)90229-7","article-title":"Arthroscopic treatment of bilateral Freiberg\u2019s infraction.","volume":"12","author":"Maresca","year":"1996","journal-title":"Arthroscopy"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"208","DOI":"10.5435\/00124635-200704000-00004","article-title":"Osteonecrosis in the foot.","volume":"15","author":"DiGiovanni","year":"2007","journal-title":"J Am Acad Orthop Surg"},{"key":"ref321","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1302\/0301-620X.67B1.3155745","article-title":"Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment.","volume":"67","author":"Ficat","year":"1985","journal-title":"J Bone Joint Surg Br"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3113\/FAI-2009-0167","article-title":"Current concepts review: Freiberg\u2019s disease.","volume":"30","author":"Carmont","year":"2009","journal-title":"Foot Ankle Int"},{"key":"ref221","doi-asserted-by":"crossref","first-page":"488","DOI":"10.3113\/FAI.2008.0488","article-title":"Interpositional arthroplasty with extensor digitorum brevis tendon in Freiberg\u2019s disease: a new surgical technique.","volume":"29","author":"Ozkan","year":"2008","journal-title":"Foot Ankle Int"},{"key":"ref461","doi-asserted-by":"crossref","first-page":"488","DOI":"10.3113\/FAI.2008.0488","article-title":"Interpositional arthroplasty with extensor digitorum brevis tendon in Freiberg\u2019s disease: a new surgical technique.","volume":"29","author":"Ozkan","year":"2008","journal-title":"Foot Ankle Int"},{"key":"ref271","doi-asserted-by":"crossref","first-page":"309","DOI":"10.2106\/00004623-200302000-00019","article-title":"Quantifying the extent of femoral head involvement in osteonecrosis.","volume":"85-A","author":"Cherian","year":"2003","journal-title":"J Bone Joint Surg Am"},{"key":"ref371","first-page":"93","article-title":"Freiberg\u2019s infraction: a subchondral bone fatigue fracture. A new surgical treatment.","volume":"142","author":"Gauthier","year":"1979","journal-title":"Clin Orthop Relat Res"},{"key":"ref91","doi-asserted-by":"crossref","first-page":"483","DOI":"10.3109\/17453679909000985","article-title":"Surgery for symptomatic Freiberg\u2019s disease: extraarticular dorsal closing-wedge osteotomy in 13 patients followed for 2\u20134 years.","volume":"70","author":"Chao","year":"1999","journal-title":"Acta Orthop Scand"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/101\/4\/335\/1406680\/1010335.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/101\/4\/335\/1406680\/1010335.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:12:05Z","timestamp":1783505525000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/101\/4\/335"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,7,1]]},"references-count":48,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2011,7,1]]}},"URL":"https:\/\/doi.org\/10.7547\/1010335","relation":{},"ISSN":["8750-7315","1930-8264"],"issn-type":[{"value":"8750-7315","type":"print"},{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,7,1]]}}}