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
- Collapse
II Collapse. central resorption of bone within the metatarsal head causes the subchondral bone to subside. [orthofracs.com]
II – Collapse. central resorption of bone within the metatarsal head causes the subchondral bone to subside. III – Peripheral irregularities present. [boneandspine.com]
Although it is considered to represent an interruption of normal growth processes, the specific events or factors that incite the cascade leading to articular collapse are unclear. [emedicine.medscape.com]
[…] of the dorsal central portion of the affected metatarsal head, alteration in the contour of the metatarsal head and a slight increase in the joint space III Further deformation and collapse of the metatarsal head, with osteolysis and flattening of the [medical-dictionary.thefreedictionary.com]
Radiographs showed collapse of the second metatarsal heads and epiphysial irregularities of the fifth metatarsal heads and the condyle of the proximal phalanx of the hallux of both feet. [ncbi.nlm.nih.gov]
- Toe Swelling
Causes of Freiberg’s disease Foot injury or trauma Having longer-than-normal metatarsal bones Wearing very high heeled shoes Symptoms of Freiberg’s disease Pain localized to the head of the second toe Swelling and stiffness in the metatarsophalangeal [syracusepodiatry.org]
- Localized Pain
Symptoms for the condition include vague and poorly localized pain in the patient’s forefoot. Others include stiffness in the joint and a limp that results from the breakdown in bone tissue that happens at the metatarsal head of the second toe. [austinfootandankle.com]
Musculoskeletal
- Short Legs
leg walking cast until symptoms subside, usually in 3-4 weeks; - surgical indications: rare: - failure of conservative treatment; - surgery may be warrented to remove metatarsal heads Freiberg Disease Complicating Unrelated Trauma. [wheelessonline.com]
If symptoms are severe, consider immobilising the foot in a short leg walking cast until the symptoms subside – usually within 3-4 weeks. Surgical This is rarely used, but the most usual indication is failure of conservative treatment. [thefootandankleclinic.com.au]
If symptoms are severe, consider immobilising the foot in a short leg walking cast until the symptoms subside - usually within 3-4 weeks. Surgical This is rarely used, but the most usual indication is failure of conservative treatment. [patient.info]
leg walking cast results level 4 evidence all patients experience improvement 80% return to normal ROM Arthoscopic Joint Debridement only case studies Perichondral grafting Aim Stage I -III elevate depressed articular fragment with bone grafting Technique [orthofracs.com]
- Small Foot
Atrophy of intrinsic small foot muscles secondary to neuropathy, which is prevalent in diabetes mellitus, may play a part in the development of Freiberg's infraction. [ncbi.nlm.nih.gov]
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]
Surgical Treatment of Freiberg's Infraction in Athletes. Frieberg's disease: A suggested pattern of management. Original Text by Clifford R. Wheeless, III, MD. [wheelessonline.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]
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]
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]
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]
Although trauma and circulatory disturbances likely contribute major roles in its development, it is widely accepted that Freiberg’s etiology is multifactorial. [ncbi.nlm.nih.gov]
Though Freiberg thought trauma as the cause of the condition exact etiology has still not been explained. Freiberg disease in adults is thought to represent a different process though they have similar radiological features. [boneandspine.com]
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]
[…] 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]
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]
Restoring the Bone Tissue Freiberg’s disease does need to be treated to prevent permanent side effects, like continued degenerative joint disease. [parkerpodiatry.com]
Activity modification during exacerbations may help to prevent the aggravating symptoms of pain and swelling. Symptomatic analgesic drugs might be taken. Few physicians recommend steroid injections too. [boneandspine.com]