II. Epidemiology

  1. Affects teens
  2. Girls predominate by a factor of 3-4
  3. Most associated with ballet and dance

III. Pathophysiology

  1. Unknown etiology, but presumed due to microtrauma, decreased vascular supply or systemic conditions
  2. Disordered ossification of the Metatarsal head (most often the second Metatarsal)
    1. Avascular necrosis (or aseptic necrosis) of the seccond Metatarsal head (other toes may be involved)

IV. Risk Factors

  1. Trauma
  2. Repetitive stress
  3. Improper shoes
  4. Decreased blood supply to the affected area

V. Symptoms

  1. Pain and swelling localized to the affected metarsal head
  2. Typically unilateral (90% of cases)
  3. Worse with weight bearing or walking

VI. Signs

  1. Metatarsal-phalangeal joint (MTP) inflammation
    1. Tenderness and swelling over the involved Metatarsal head
    2. Restricted Range of motion
  2. Metatarsal head palpably enlarged

VII. Imaging

  1. Weight-Bearing Foot XRay
    1. XRay Findings may lag symptom onset by 3-6 weeks
    2. Sclerosis and flattening of the involved articular surface of the Metatarsal head
    3. Widening and irregularity of Metatarsal head
    4. Flattening and collapse of MTP joint with cystic changes
    5. Loose bodies sometimes present
  2. MRI
    1. Consider when serial XRays fail to make the diagnosis

VIII. Management

  1. NSAIDs
  2. Warm soaks
  3. Local Corticosteroid Injection
  4. Well padded shoes
  5. Stiff soled shoe or walking boot
  6. Anterior Metatarsal bar or pad
    1. Shifts pressure from Metatarsal head
  7. Surgery indications
    1. Loose bodies
    2. Significantly deformed Metatarsal head

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Ontology: Freiberg's disease (C0264099)

Concepts Disease or Syndrome (T047)
MSH C535636
SnomedCT 28466007
Dutch ziekte van Freiberg, Freiberg; osteochondrose, infractie; Freiberg, osteochondrose; Freiberg
French Maladie de Freiberg
German Freiberg-Krankheit
Italian Malattia di Freiberg
Portuguese Doença de Freiberg
Spanish Enfermedad de Freiberg, infracción de Freiberg, osteocondrosis juvenil del segundo hueso metatarsiano (trastorno), osteocondrosis juvenil del segundo hueso metatarsiano
Japanese フライバーグ病, フライバーグビョウ
English juvenile osteochondrosis of second metatarsal (diagnosis), juvenile osteochondrosis of second metatarsal, Freiberg-Kohler syndrome, Kohler's second disease, Freiberg's disease, Second metatarsal osteochondrosis, freiberg's infraction, freiberg's disease, Freiberg's infraction, Juvenile osteochondrosis of second metatarsal, Juvenile osteochondrosis of second metatarsal (disorder), Freiberg; osteochondrosis, Freiberg, infraction; Freiberg, osteochondrosis; Freiberg, Osteochondrosis of Freilberg, Osteochondrosis of second metatarsal
Czech Freibergova nemoc
Hungarian Freiberg betegség