- 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
- 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.
Surgical Treatment of Freiberg's Infraction in Athletes.
Frieberg's disease: A suggested pattern of management.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Thursday, April 12, 2012 10:05 am