Understanding Freiberg's Disease
Understanding 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 Disease
If 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
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
Many 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.