Freiberg’s disease

December 31, 2014

Overview

Understanding Freiberg's disease requires knowledge of the ossification process in the metatarsal bones of the feet. Each of the metatarsals are ossified from two centers; metatarsals 2 through 5 have one center for the body of the metatarsal and another for the head; the first metatarsal has one center for the body and one for its base. Ossification begins in the center of the body during the ninth week of life. The center for the base of the first metatarsal appears in the third year of life; the centers for the other metatarsal heads appear between the fifth and eighth year of life. Throughout adolescence, the epiphysis and metaphysic are separated by a narrow epiphyseal plate. The epiphysis ossifies to the metaphysic between 18 and 20 years of age.

Symptoms

Early signs of this condition can be detected with x-rays; they will show a rarefaction of the metaphysic with sclerosis of the epiphysis. The distal end of the affected metatarsal is flattened, the shaft is hypertrophied and the head may appear somewhat fragmented. If diagnosed early, treatment should involve reducing stress on the metatarsal. Padding of varying degrees can help to balance or eliminate stress under the affected metatarsal. Physical therapy can also attenuate the discomfort associated with this condition. If extensive osteophytic changes result and deform the affected metatarsal, it can also impinge on and affect the adjacent metatarsal. Surgical intervention may be necessary to remodel the joint. Surgery should aim to keep the metatarsal parabola intact to avoid transfer lesions.

Diagnosis

Many patients suffering from Freiberg's disease are asymptomatic. Often the diagnosis is made as secondary to x-ray findings for another manifested foot ailment. When a patient complains of pain in the second metatarsal Freiberg's disease should be considered as a possible underlying cause. Metatarsal phalangeal joint crepitus and pain are symptoms that, combined with x-rays, can usually lead to this diagnosis

Treatment

nitial 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;