What is Freiberg’s disease?
Freiberg’s disease is an uncommon condition where a lesser metatarsal head bone essentially dies. Most commonly this condition affects the second metatarsal head. It is also called Freiberg’s infraction and is a type of avascular necrosis. The exact cause is unknown but is thought to be due to excessive stress to the metatarsal head resulting in a vascular insult and total joint destruction in the later stages. Pain and swelling in the ball of the foot are the most common symptoms.
An X-ray will usually reveal a flattening of the metatarsal head in the early stages and complete joint collapse in the late stages. An MRI or CT scan are often recommended for surgical planning.
Nonsurgical treatment would consist of a period of non-weightbearing immobilization in a cast or cast boot for 6 weeks in the early stages. The use of a bone stimulator may also be used to aid in bone healing.
In the early stages, drilling small holes in the metatarsal head combined with a period of non-weightbearing can stimulate the bone to heal. If the area of dead bone is isolated a “tilt up” bone cut or osteotomy may be performed to reposition the area involved. If the entire joint is involved, a type of procedure called an interpositional arthroplasty is typically recommended. This procedure involves removing the excess bone from the joint and taking a small piece of tissue, usually from the calf, and using it as a pillow in the joint. Recovery time usually consists of 6 weeks non-weightbearing.
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