Freiberg Disease and the role autologus matrix induced chondrogenisis may play as a new treatment option.     

In this edition of the Daisy Digest, we worked with Kailash Devalia to present his findings of Autologous Matrix Induced Chondrogensis for Freibergs Disease.   Mr Devalia is keen to work with specialists in the UK and potentially further afield to develop a multi-centre registry and data set for this technique. 

What is Freiberg’s Disease?

Freiberg’s disease is a condition that primarily affects the second or third metatarsal. Although people of all ages can be affected by this condition, Freiberg’s disease is most commonly diagnosed during adolescence through the second decade of life. Common signs and symptoms include pain and stiffness in the front of the foot, which often leads to a limp. 


  • Avascular necrosis of second Metatarsal head
  • Often affects teenage girls but can present later
  • Presents with constant pain, discomfort with weight-bearing, inability to carry on daily work & social activities
  • Loss of cartilage
  • Necrotic oedematous underlying bone
  • Subchondral fracture
  • Flattening/reversal of convexity of MT head


  • Idiopathic
  • High Heels
  • Long Mt2
  • Systemic Disease
  • Traumatic
  • Steroids

Current Treatment Options 

The current standard treatment option is typically Cheilectomy which allows the removal of osteophytes. This will allow improvement in impingement pain and mobility in the MTP2 joint.

However, these are short term wins as the issue usually recurs, and you are not changing the underlying environment.

Whats the best option?

The one that suits the patients needs 

Classification and treatment




  • Contained: Cortical shell intact
  • Uncontained: Deficient cortical walls
  • Guides the harvest

Perform Cheilectomy

Bone Marrow Stimulation 

Bone Grafting Defect 

AMIC with ChondroGide 

Results so far…..

8 lesser MTPs

  • Gender: F: 6.   M: 2

  • Age: Lesser MTP – 43 (19 – 60 years)

Case reports 

These first two sets of images demonstrate the repair, with short term follow-up in clinic of around 6 weeks. 

This third case report, 18 year old female came in to clinic around 16 months for follow-up.


  • Painful bend foot, the pain was sometimes 9/10
  • limited with shoe types, unsure about being able to take driving lessons
  • some mornings unable to walk
    Audio: 16 months postoperatively taken from clinic.

    16 months post-op

    • Going to gym
    • Wearing regular and varied footwear
    • Starting driving lessons 

    Final thoughts and conclusion from Mr Devalia 

    • The overall prognosis with Freiberg’s disease is guarded. There is not a single procedure that has demonstrated long term good outcomes.
    • AMIC for Freiberg disease with bone grafting appears to give consistent results; however, the long term outcome is unknown.
    • Younger patients with biological plasticity appear to do well with AMIC.
    • Autologous bone grafting seems to help remodel the MT2 head; improve the vascularity, which in turn helps the membrane mature.
    • I believe that any adjuncts that increase MT head vascularity (e.g. Osteotomy or Autologous bone grafting) used in conjunction with AMIC will help the ChondroGide membrane to mature into hyaline cartilage. This will improve the long term outcome of this rare disease.

    Thanks to Mr Kailash Devalia for his contribution to this edition of The Daisy Digest.

    Working with Mr Devalia as the lead surgeon, Joint Operations are keen to speak to as many Foot and Ankle Specialists in the UK who would be interested in pooling their data in the national AMIC Freiberg evaluation group.

    Please get in touch with our Group Marketing Manager Jim Carr for further details if you are interested. 

    Jim Carr

    Group Marketing Manager

    Jim leads the Marketing team at Joint Operations. This is a multifaceted role, producing the material with which we communicate, our education programme and evolving the strategic development of the business. 

    Call Jim


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