Interpositional arthroplasty with palmaris longus tendon graft for osteonecrosis of the second metatarsal head: a case report.

Osteonecrosis of the second metatarsal head is often attributed to Freiberg's disease. We describe the case of a 27-year-old Taiwanese male soldier with persistent painful disability of the right forefoot of 9 months' duration, but no history of trauma. A series of radiographs suggested the diagnosis of late-stage Freiberg's disease. The lesion was treated with interpositional arthroplasty using a palmaris longus tendon graft, in a modification of the traditional interpositional arthroplastic technique for treating Freiberg's disease. After 2 years of follow-up examinations, the patient was satisfied with the clinical outcome, despite having a limited range of motion of the right second metatarsophalangeal joint relative to the adjacent toes. The patient returned to his army group with functional activity that was better than he had experienced before surgery. We believe this modified interpositional arthroplastic treatment strategy will provide more symptom relief and satisfactory functionality for the treatment of late-stage Freiberg's disease.