Freiberg's disease is a rare osteochondrosis of the second or third metatarsal head, and its etiology is not well understood. Lack of arterial supply and mechanical stress to the metatarsal head is speculated to be the probable etiology [1
]. The classification of Freiberg's disease is differentiated from stage I (fissure fracture) to stage V, with the latter being the final stage of flattening deformity of the metatarsal head and osteoarthritis of the MTP joint [2
Excision of the proximal phalangeal base and/or the metatarsal head, which is technically easy to perform, has a possibility of risk of progressive hallux valgus, metatarsal pain, and shortening of the toe [3
]. Prosthetic joint replacement is a final option for late-stage Freiberg's disease, but possible implant failure and the risk of synovitis risk exist because the typical patient with Freiberg's disease is an adolescent girl with a high physical activity level [3
]. An acceptable result was achieved in our patient by performing dorsiflexion osteotomy of the metatarsal bone, the surgical concept of which is that the dorsal necrotic region is rotated and replaced by the intact plantar segment of the metatarsal head [3
]. This is a reliable treatment option for Freiberg's disease; however, it carries the risk of necrotic changes in the metatarsal head. In addition, remodeling using this technique cannot re-create an anatomically normal articular surface. Recently, autologous osteochondral plug transplantation has been developed, which has had good results for the treatment of cartilaginous lesions of the femoral condyle of the knee and reconstruction of the articular surface to its normal shape without any internal fixation of the defect [6
]. Miyamoto et al.
] described four cases of Freiberg's disease, stage III or IV, treated with osteochondral transplantation. An autologous osteochondral plug harvested from the femoral condyle was transplanted into the hole made in the damaged second metatarsal head, and satisfactory results were obtained in all cases. In the present report, we describe treatment of a patient who had stage III Freiberg's disease with autologous osteochondral plug transplantation. We used a relatively large, cylindrical osteochondral graft (6 mm in diameter) harvested from the femoral condyle, because it is important that the plug should be as large as possible to ensure a press-fit into the defect. In the present case, the patient's foot pain was alleviated, the graft was united with the host bone, and the articular surface of the second metatarsal was shown radiographically to be well remodeled.