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Freiberg’s Disease

- 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.
Surgical Treatment of Freiberg's Infraction in Athletes.

Frieberg's disease:  A suggested pattern of management.