Freiberg’s Infraction / Avascular Necrosis Of The Metatarsal Head
Definition
Freiberg’s disease is avascular necrosis of the metatarsal head, most commonly the second metatarsal head. It is generally traumatically induced or the result of a long standing repetitive stress that causes micro-fractures that restrict circulation resulting in bone death. It is more common in females than males and occurs most often during puberty.
Signs and symptoms
- Pain and swelling around the affected metatarsal head
- Pain with activity
- Pain wearing high heeled shoes
- Stiffness in the joint
Diagnosis
Diagnosis is made easily in the later stages when flattening and sclerosing of the metatarsal head can be seen on x-rays. In the earlier stages it can be confused with capsulitis, plantar plate syndrome, and stress fracture. A thorough history and physical can help narrow down the true diagnosis. If there is a high index of suspicion and MRI can help diagnose Freiberg’s in the early stages.
Treatment
The treatment of Freiberg’s disease depends on the stage on presentation. If caught early (Stage 1-3) the degeneration of the joint can be prevented or arrested with 6-8 weeks of immobilization and crutches followed by custom molded orthotics to eliminate the stressors that lead to the condition. Once the bone shows signs of degeneration (stages 4-5) surgical intervention may be necessary to relieve symptoms and restore range of motion.
Surgical options include debridement, osteotomy, arthroplasty, or joint implants. The goal is to relieve pain and maintain function.
