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Freiberg's Disease


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]
Pain
  • It is typically a chronic, progressive process, eventually causing pain and loss of normal function of the metatarsophalangeal joint.[ncbi.nlm.nih.gov]
  • Choose comfortable footwear; avoid high heels, use metatarsal pads to support the painful area. - Intensive pain and swelling require applying a cast to completely immobilize the area for about a month.[docpods.com]
Swelling
  • 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]
  • Physical Examination In Freiberg’s disease, examination often reveals swelling and localized tenderness at the ball of the foot and the joint associated with the involved toe.[footeducation.com]
  • Symptoms of pain, stiffness and swelling around the affected toe, often the 2 nd, can occur in teens or early adulthood. It is usually worse on wearing high heels with pain under the ball of the foot.[londonorthopaedicsurgery.co.uk]
Inflammation
  • This allows mechanical inflammation and irritation to decrease and provides pain relief and comfort for our patient. We may prescribe or recommend medication that will help subside the pain and inflammation that accompanies the disease.[austinfootandankle.com]
  • Swelling may become apparent if there is inflammation of the synovial membrane on the inside of the joint. The exact cause of this condition is unclear. Some, but not all, cases can be traced to a traumatic injury.[shenandoahpodiatry.com]
  • Freiberg's disease [ fri bergz ] osteochondrosis of the head of the second metatarsal bone. osteochondritis Orthopedics Inflammation of bone and joint surfaces–usually aseptic; note: A legacy of the German school of medicine was eponymic immortalization[medical-dictionary.thefreedictionary.com]
  • Over time, as the inflammation resolves, the bone in the metatarsal head heals or re-vascularizes and symptoms will decrease. However, there may be some residual deformity in the joint, resulting in mild discomfort that persists over time.[footeducation.com]
  • Operative treatment: this involves tidying up the joint (also known as debridement) to reduce inflammation and help relieve the symptoms.[fortiusclinic.com]
Surgical Procedure
  • Several surgical procedures have been recommended. A new surgical procedure similar to the present treatment of hallux rigidus with a silicone rubber implant is described.[ncbi.nlm.nih.gov]
  • Surgical procedures for Freiberg's disease include the following: (1) debridement of the metatarsal with removal of loose bodies, (2) dorsiflexion osteotomy of the distal metatarsal, and (3) shortening osteotomy of the metatarsal.[gait.aidi.udel.edu]
  • Conservative treatment methods are often successful in the cases we see, but there are rare instances when a severe case may require a surgical procedure.[austinfootandankle.com]
  • If the fifth metatarsal heals improperly, or fails to heal, a surgical procedure is often warranted to repair the situation. This can greatly lengthen your recovery time and reduce your chance for a pain free, satisfying result.[ahni.com]
  • Hoskinson described 12 patients treated with various surgical procedures, including excision of the metatarsal head (n 4), hemiphalangectomy (n 4), and debridement with loose-body excision (n 4).[emedicine.medscape.com]
Falling
  • Our patient presented with acute pain, swelling, and point tenderness of the forefoot after a minor fall. Radiographs revealed a fracture through the head of the second metatarsal and underlying avascular necrosis consistent with Freiberg's disease.[ncbi.nlm.nih.gov]
  • When you develop a condition that falls outside the normal scope of injuries and diseases, it is important to understand your symptoms and know when it is time to see our podiatrists. An example of this is Freiberg’s disease.[austinfootandankle.com]
  • At Walk Without Pain, our specialists recognise that this is a rare condition and something that causes serious problems for those that fall victim to it.[walkwithoutpain.com.au]
  • The patients who do not respond to conservative treatment in the above-listed stages as well those who fall in stage IV & V require surgery. The goal of therapy is to rest the joint to allow inflammation and mechanical irritation to resolve.[boneandspine.com]
Hyperkeratosis
  • […] interposition IV epiphyseal dysplasia multiple head involvement as indicated for types I, II, III History Typical presentation female adolescent growth spurt pain 2nd metatarsal head worse with weight bearing may wake patient from sleep Examination Look swollen hyperkeratosis[orthofracs.com]
Foot Pain
  • Normally, patients present to the Emergency Department with atraumatic foot pain, however, as we illustrate with this case, an acute fracture may occur, requiring recognition and appropriate treatment.[ncbi.nlm.nih.gov]
  • I mainly would like to know how they manage the foot pain (I am awaiting an orthotic appointment at the hospital) and whether they are able to run. It is a relief to finally have a diagnosis for my foot pain.[therunningbug.com]
  • Custom foot orthotics from Advanced Foot & Ankle can help relieve foot pain caused by Freiberg’s disease. This non-surgical treatment may take between one and two months to fully take effect.[advancedfootanklewi.com]
  • Foot pain. Foot stiffness. Walking with a limp. The disease progresses in stages. Stages I and II are characterized by the formation of relatively minor joint lesions or patches of abnormal tissue.[summerlinfootandankle.com]
  • DUPONT INSTITUTE WILMINGTON, DELAWARE CASE HISTORY: HISTORY: 15 4 year old female with left foot pain near the fourth toe for one year. She had no antecedent trauma.[gait.aidi.udel.edu]
Arthritis
  • There was no case of infection, avascular necrosis, arthritis or pseudoarthrosis.[ncbi.nlm.nih.gov]
  • Freiberg’s disease is a rare condition that can become a debilitating ailment if not treated properly; it can even cause the onset of arthritis at a young age.[shenandoahpodiatry.com]
  • […] lateral xray IV loose bodies V complete degeneration of 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[orthofracs.com]
  • Differential diagnosis Arthritis Bone tumor Bursitis Capsulitis Gout Lupus Morton's Neuroma Pseudogout Psoriatic arthritis Rheumatoid arthritis Septic joint Stress fractures Treatment Treatment of Freiberg's infraction tends to vary based upon the degree[myfootshop.com]
  • […] in Sports 514 Rotator Cuff Tears 516 Scapholunate Dissociation 518 Sciatica 520 Scoliosis 522 SCUBA Diving Injuries: DCS and AGE 524 Seizures and Epilepsy 526 Septic Arthritis and Bursitis 528 Sesamoid Dysfunction 530 Sever Disease/Calcaneal Apophysitis[euro-libris.ro]
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]
Knee Pain
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]
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]
Confusion
  • In about 10 per cent, bilateral flat configuration of the second metatarsal head accompanied by a joint space wider than in the neighbouring joints was found, and is therefore a normal anatomic variant that must not be confused with Freiberg's disease[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]

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

  • The importance of this and other possible etiologic factors is discussed.[ncbi.nlm.nih.gov]
  • 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]
  • There is some controversy as to the etiology, as it is unclear as to whether this is a result of trauma or primary avascular necrosis of the metatarsal head.[gait.aidi.udel.edu]

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]
Sex distribution
Age distribution

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]

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