- Discussion:
- anterior metatarsalgia that involves head of second metatarsal;
- occurs during the growth spurt at puberty - most are female;
- caused by avascular necrosis of the metatarsal head;
- from repetitive stress with microfractures at the junction of the
metaphysis and the growth plate
- these fractures deprive the epiphysis of adequate circulation;
- disease is more common in pts whose 1st metatarsal is shorter than
2nd metatarsal, which increases wt on 2nd metatarsal head;
- in adulthood, DJD may develop in MTP joint;
- Clinical Manifestations:
- pain in the forefoot, usually localized to head of the second metatarsal;
- wearing of high heeled shoes makes condition worse;
- localized swelling and limitation of motion in MP joint;
- Radiologic Findings:
- initially the epiphysis becomes sclerotic;
- early in disease, joint space is widened, much later, it narrows & irregular
bony surfaces, sclerosis, & bone spurs at margins give the appearance
of osteoarthritis;
- epiphysis becomes fragmented followed by osteolysis & reconstitution
of bony archetecture;
-
fragmentation and osteolytic phases:
- metatarsal head becomes irregular, widened, and flattened at
articular surface;
- Diff Dx:
-
Ewing's Sarcoma
-
Stress Fracture
-
Osteosarcoma
- Treatment:
- initial management includes proper foot wear w/ metatarsal bar or pad placed
beneath the involved bone;
- limit activity for four to six weeks;
- w/ severe symptoms consider immobilizing foot in short leg walking cast
until symptoms subside, usually in 3-4 weeks;
-
surgical indications: rare:
- failure of conservative treatment;
- surgery may be warrented to remove metatarsal heads;
Freiberg Disease Complicating Unrelated Trauma.
Binek,R. et al. Orthopedics 11:5. pp.753-57. 1988.
Surgical Treatment of Freiberg's Infraction in Athletes.
American Journal of Sports Medicine. 21:3. pp.381-4. 1993.
Frieberg's disease:
A suggested pattern of management.
B. Helal and P Gibb.
Foot Ankle. Vol 8. 1987. p 94-102.
