27 athletes with Freiberg's disease were randomized to receive surgical intervention via an Osteochondral Autologous Transplantation (OAT) or a Dorsal Closing Wedge Metatarsal Osteotomy (DCWMO). The primary outcomes of interest were the American Orthopaedic Foot and Ankle Society - lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, pain on the Visual Analog Scale for foot and ankle (VAS-FA), dorsiflexion and plantarflexion range of motion, change in metatarsal length, and the time to return to sports and training. Follow-up was performed up to 3 years post-operation. Results revealed significantly favourable AOFAS-LMI scores in the OAT group compared to the DCWMO group at 1 and 3 years post-operation. The time to return to sports and training was significantly faster in the OAT group compared to the DCWMO group. No significant differences were observed between the two groups in VAS-FA scores, plantarflexion and dorsiflexion range of motion, or the change in metatarsal length.