Presentation
Presenting symptoms include vague pain, swelling, and loss of motion in the involved metatarsophalangeal joints. Low-grade osteomyelitis often is difficult to identify. [ncbi.nlm.nih.gov]
Stiffness in the involved joint may be present. Radiographic Findings : In the early phase, subchondral fractures may be present. As the disease progresses, resorption of the necrotic bone occurs, with epiphyseal fracture. [gait.aidi.udel.edu]
In acute presentations, a simple below knee non-weight-bearing cast may be sufficient. In nonacute presentations, weight bearing cast may be given. [boneandspine.com]
Entire Body System
- Weakness
He theorized that with forcible impact in feet predisposed by weakness of the toe flexors (especially the first toe), the longer second toe would be susceptible to injury. [emedicine.medscape.com]
[…] reason for being most affected Metatarsal skeletal immaturity adolescence is typical time of onset weakness of metatarsal epiphysis at certain stage of epiphyseal maturation centre of ossification lesser metatarsals 5-8 years old fusion 18-20 years old [orthofracs.com]
In 1959, Braddock observed that there is a relative weakness of the second metatarsal epiphysis at a certain stage of epiphyseal maturation. [3] Whatever the etiology, the result appears to cause cartilage lifting and separation from the underlying subchondral [faoj.org]
- Fever
[…] surgeon and William Stokes (1804 -1878) Irish physician, Chiari キアリ Chiari's malformation キアリ奇形 Hans Chiari(1851 − 1916) German pathologist= Arnold Chiari malformation, Budd-Chiari syndorome の Chiari も同一人物 Chikungunya チクングンヤ Chikungunya hemorrhagic fever [jams.med.or.jp]
Musculoskeletal
- Fracture
Identifying the underlying chronic process was important in understanding how minor trauma resulted in a fracture in this patient. [ncbi.nlm.nih.gov]
This type of fracture my also represent an old stress fracture which has progressed to a complete fracture. [ahni.com]
222 Fracture, Middle Phalanx 224 Fracture, Nasal 226 Fracture, Olecranon 228 Fracture, Orbital 230 Fracture, Patella 234 Fracture, Pelvic 236 Fracture, Posterior Malleolus 238 Fracture, Proximal Phalanx 240 Fracture, Proximal Tibia 242 Fracture, Radial [euro-libris.ro]
Physical stress causes multiple tiny fractures where the middle of the metatarsal meets the growth plate. These fractures impair blood flow to the end of the metatarsal resulting in the death of bone cells (osteonecrosis). [en.wikipedia.org]
[…] head of second metatarsal; - occurs during the growth spurt at puberty - most are female; - caused by avascular necrosis of the metatarsal head; - from repetitive stress with microfractures at the junction of the metaphysis and the growth plate - these fractures [wheelessonline.com]
- Osteophyte
[…] parts of the affected metatarsal head, with joint incongruence and permanent deformity V Advanced degenerative arthrosis due to ongoing flattening of the metatarsal head and articular destruction; the base of the proximal phalanx becomes irregular with osteophyte [medical-dictionary.thefreedictionary.com]
Decompression only case reports (level 4 evidence) 1.1 mm K wire used to drill mulitple holes in metatarsal head Open Joint Debridement (level 4 evidence) excision of thickened synovium removal of loose bodies delaminated articular cartilage resection of osteophytes [orthofracs.com]
The ideal length of immobilization should be four to six weeks and return to activity should be gradual thereafter. 2 The most simple surgical approach to early-stage Freiberg’s disease is a cheilectomy with cleanup of the joint and removal of any osteophytes [podiatrytoday.com]
Neurologic
- Seizure
Eye 504 Redundant Plica 506 Renal Trauma 508 Retinal Detachments and Tears 510 Rhabdomyolysis 512 Rheumatoid Arthritis in Sports 514 Rotator Cuff Tears 516 Scapholunate Dissociation 518 Sciatica 520 Scoliosis 522 SCUBA Diving Injuries: DCS and AGE 524 Seizures [euro-libris.ro]
[…] syndrome ハーラー症候群 GertrudHurler(1889-1965) Germanpediatrician Hutchinson ハッチンソン Hutchinson's teeth ハッチンソン歯 Hutchinson-Gilford ハッチンソン・ギルフォード Hutchinson-Gilford syndrome ハッチンソン・ギルフォード症候群 Ivemark イヴェマルク Ivemark syndrome イヴェマルク症候群 Jackson ジャクソン jacksonian seizure [jams.med.or.jp]
- Hyperactivity
The scintigraphic pattern of a photopenic defect with hyperactive collar is demonstrated as evidence of the existence of avascular necrosis or infarction in this entity. [ncbi.nlm.nih.gov]
Plain X-ray appearance On X-ray (see 'Classification', below), the second metatarsal head has a flattened appearance with areas of increased sclerosis and fragmentation. [ 1 ] Bone scans Bone scanning may demonstrate a centre of reduced activity with a hyperactive [patient.info]
Workup
X-Ray
- Joint Space Narrowing
RADIOGRAPHS: Radiographs revealed flattening of the metatarsal head and joint space narrowing. [gait.aidi.udel.edu]
Severe joint space narrowing and arthrosis characterize end-stage Freiberg’s infraction. 1,2 Magnetic resonance imaging (MRI) is a useful tool in evaluating the condition of the joint before plain radiographic changes are visible. [podiatrytoday.com]
Treatment
Freiberg's disease is an osteochondrosis of the IInd metatarsal head that prevalently develops during the second decade of life and that is the cause of important painful symptoms that resist conservative treatment. [ncbi.nlm.nih.gov]
Non-Operative Treatment Options Operative Treatment Options Surgical management is reserved for patients who have failed to respond to non-operative treatment. [lfaclinic.co.uk]
In some instances, your doctor my recommend surgical treatment if the fracture is displaced or the fracture fragment is relatively large. [ahni.com]
Prognosis
Prognosis The condition may continue to worsen after adolescence into adulthood. Deformity and degenerative changes of the MTP joint may occur. [link.springer.com]
Prognosis Fortunately, the outcomes of both non-operative and operative management are good to excellent and most patients are able to return to previous activity. [thefootandankleclinic.com.au]
Home Adult Elective Disorders Foot | Ankle Freiberg's Disease Video Definition Aetiology Epidemiology Anatomy Pathology Classification History Examination Investigations Differential Diagnosis Treatment Complications Prognosis References First reported [orthofracs.com]
Options include: Debridement Bone grafting Osteotomy [ 9, 10 ] Arthroplasty Osteochondral transplantation [ 7 ] Prognosis Fortunately, the outcomes of both non-operative and operative management are good to excellent and most patients are able to return [patient.info]
Etiology
In his original description, Freiberg favored a traumatic etiology; however, he admitted that trauma itself could not reliably explain all cases. [3] Despite several thoughtful investigations into the etiology of Freiberg disease, no consensus exists [emedicine.medscape.com]
The importance of this and other possible etiologic factors is discussed. [ncbi.nlm.nih.gov]
Epidemiology
Home Adult Elective Disorders Foot | Ankle Freiberg's Disease Video Definition Aetiology Epidemiology Anatomy Pathology Classification History Examination Investigations Differential Diagnosis Treatment Complications Prognosis References First reported [orthofracs.com]
Freiberg. [ 2 ] Epidemiology It is difficult to ascertain the true incidence of Freiberg's disease, as many cases may resolve spontaneously before treatment has been sought. Most series in the literature have small numbers. [patient.info]
Pathophysiology
Surgical management can broadly be categorized as procedures which attempt to correct the pathophysiology and halt its progression, and procedures which address the sequelae of later stage disease. [ncbi.nlm.nih.gov]
Prevention
The disease is quite rare and must be treated surgically during its early phase in order to prevent progression that may result in permanent changes in the metatarsal head. [ncbi.nlm.nih.gov]
Treatment in the early stage of this disease involves immobilizing the foot to prevent further destruction of the bone that occurs by bearing weight on the ground. [inpodiatrygroup.com]
[…] joint MRI and Bone Scan Theoretically useful, but only case studies in literature of being used to diagnose early disease Differential Diagnosis stress fractures joint sepsis tumour metatarsalgia arthritis Treatment Nonoperative Aim improve symptoms prevent [orthofracs.com]
Restoring the Bone Tissue Freiberg’s disease does need to be treated to prevent permanent side effects, like continued degenerative joint disease. [parkerpodiatry.com]