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Freiberg's Disease
Understanding Freiberg's DiseaseUnderstanding Freiberg's disease requires knowledge of the ossification process in the metatarsal bones of the feet. Each of the metatarsals are ossified from two centers; metatarsals 2 through 5 have one center for the body of the metatarsal and another for the head; the first metatarsal has one center for the body and one for its base. Ossification begins in the center of the body during the ninth week of life. The center for the base of the first metatarsal appears in the third year of life; the centers for the other metatarsal heads appear between the fifth and eighth year of life. Throughout adolescence, the epiphysis and metaphysic are separated by a narrow epiphyseal plate. The epiphysis ossifies to the metaphysic between 18 and 20 years of age. Relationship of trauma and Freiberg's DiseaseIf during this time (when the epiphysis is still present), the blood supply is interrupted by trauma, epiphysitis occurs. It is believed that a micro fracture happens at the epiphyseal plate since it is somewhat calcified and vulnerable. This fracture could be due to endocrine disorder, trauma or infection. The exact etiology is still debatable and somewhat unclear. Trauma in the second metatarsal seems to be a plausible cause since it is usually the longest metatarsal in the parabola and excessive stress may be noticeable. In females, this condition is most often located in the second metatarsal. Epiphysitis leads to aseptic necrosis, in turn leading to decalcification at the metatarsal head. Degeneration ensues, continuing for about one year from onset; this is then followed by regeneration that leaves osseous hypertrophy of the bone. Loose bodies are often found in the joint along with crepitus. SYMPTOMS AND TREATMENTS of Freiberg's Disease Early signs of this condition can be detected with x-rays; they will show a rarefaction of the metaphysic with sclerosis of the epiphysis. The distal end of the affected metatarsal is flattened, the shaft is hypertrophied and the head may appear somewhat fragmented. If diagnosed early, treatment should involve reducing stress on the metatarsal. Padding of varying degrees can help to balance or eliminate stress under the affected metatarsal. Physical therapy can also attenuate the discomfort associated with this condition. If extensive osteophytic changes result and deform the affected metatarsal, it can also impinge on and affect the adjacent metatarsal. Surgical intervention may be necessary to remodel the joint. Surgery should aim to keep the metatarsal parabola intact to avoid transfer lesions. DIAGNOSIS of Freiberg's DiseaseMany patients suffering from Freiberg's disease are asymptomatic. Often the diagnosis is made as secondary to x-ray findings for another manifested foot ailment. When a patient complains of pain in the second metatarsal Freiberg's disease should be considered as a possible underlying cause. Metatarsal phalangeal joint crepitus and pain are symptoms that, combined with x-rays, can usually lead to this diagnosis.
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