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Freiberg’s Disease

Freiberg’s Disease is also commonly known as Freiberg’s infraction which means incomplete fracture or Freiberg’s infarction which means necrosis or bone death due to obstruction of circulation.

In any event the condition is a result of avascular necrosis meaning the blood supply to the affected bone has been cut causing the bone to undergo changes usually resulting in pain.

The disease can vary in severity and usually gets worse as time goes on. It usually begins in the second decade of life however may not manifest itself as pain until the patient reaches their early twenties. It is far more common in females then males.

As previously mentioned it is thought to be due to disruption of circulation to the head of the metatarsal bone, usually, but not always the second metatarsal bone. This disruption is thought to occur primarily from repetitive stress and not necessarily one incidence of trauma. The trauma is to the growth plate of the bone (from which the bone grows in length over time), which is located at the distal (front) part of the bone nearer the toes.

The repeated stress to the growth plate of the bone causes micro fractures in the growth plate which eventually lead to a disruption of the blood supply to that area of the bone. It occurs while this growth plate is open (growth plates eventually close and there is no longer any further bone growth) which is during puberty. During this time period there is rarely pain, but the pain occurs later on , generally in females in their twenties and early thirties in response perhaps to wearing high heels or participating in athletics.

Typically the patient complains of localized pain in the ball of the foot near the bone that is affected. The pain is usually exacerbated by excessive activity and can worsen overall with time.

An xray reveals the classic flattening of metatarsal head. There can also be fracture and fragmenting of the bone resulting in loose bodies of bone in the area causing further pain. All of this leads to degeneration of the joint between the metatarsal bone and toe.

The treatment of Freiberg’s disease is dependent on the amount of bone destruction and the amount of pain the patient is experiencing. In the younger patient who is in the early stages of bone destruction, the acutestage, it may be appropriate to try a non-weightbearing cast for a minimum of four weeks in an effort to prevent further bone and joint destruction. Anti-inflammatory medication may be given in conjunction with the cast to reduce symptoms.

After the cast is removed the patient should limit themselves to very conservative, stiff shanked shoes to limit the bending at the ball of the foot. An orthotic may also provide protection as well. Generally theorthotic should have a metatarsal bar built in to take pressure off the head of the bone. High heels are definitely out of the question, as is athletic endeavors. Patient compliance is a must in these situations because if the disease cannot be “quieted” down there will be further damage to the metatarsal boneresulting in chronic pain.

In those situations surgery becomes a viable option. An MRI of the bone and joint should be performed prior to any surgical procedure in order to get a clear picture of the diseased joint, to see if there are any loose bone fragments in the joint and to check the overall bone stock or quality of the metatarsal bone.

This is necessary because surgical intervention can range from a minimum of cleaning out the diseased joint of bone spicules (spurs) and loose bone bodies all the way to performing bone grafts and surgical breaking and resetting of the metatarsal bone in an effort to create better bone and joint alignment.

Even though lesser metatarsal implants exist, at this writing, there is not a general consensus that they are effective in treating Freiberg’s disease.

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