Freiberg disease

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Freiberg disease, also known as Freiberg infraction, is a condition that affects the metatarsal bones in the foot. It is characterized by the collapse of the head of the second metatarsal bone, leading to pain and stiffness in the affected area. This condition is most commonly seen in adolescents and young adults, particularly females.

Pathophysiology

Freiberg disease is believed to result from repetitive stress or trauma to the metatarsal head, which leads to a disruption in the blood supply (avascular necrosis). This lack of blood flow causes the bone tissue to die and collapse. The second metatarsal is most commonly affected due to its length and the amount of stress it endures during activities such as walking and running.

Symptoms

The primary symptoms of Freiberg disease include:

• Pain in the forefoot, particularly around the second metatarsal
• Swelling and tenderness in the affected area
• Stiffness and limited range of motion in the metatarsophalangeal joint
• Difficulty bearing weight on the affected foot

Diagnosis

Diagnosis of Freiberg disease is typically made through a combination of clinical examination and imaging studies. X-rays are often used to visualize the collapse of the metatarsal head and any associated changes in the bone structure. In some cases, magnetic resonance imaging (MRI) may be used to assess the extent of bone and soft tissue involvement.

Treatment

Treatment for Freiberg disease varies depending on the severity of the condition. Conservative treatments may include:

• Rest and avoidance of activities that exacerbate symptoms
• Use of orthotic devices to offload pressure from the affected metatarsal
• NSAIDs to reduce pain and inflammation
• Physical therapy to improve joint mobility and strength

In more severe cases, surgical intervention may be necessary. Surgical options include:

• Debridement of necrotic bone tissue
• Osteotomy to realign the metatarsal head
• Joint replacement or arthroplasty in advanced cases

Prognosis

The prognosis for Freiberg disease varies. With early diagnosis and appropriate treatment, many individuals experience significant improvement in symptoms and function. However, in cases where the condition is advanced or treatment is delayed, there may be persistent pain and limited joint mobility.

Related Pages

• Avascular necrosis
• Metatarsal bones
• Orthotic
• Nonsteroidal anti-inflammatory drug
• Physical therapy
• Osteotomy
• Arthroplasty