FREIBERG’S
By: Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.
Freiberg’s disease most commonly affects children between the ages of 10 and 15. The metatarsal head, which is one of the primary weightbearing areas of the foot, may have a temporary interruption of the blood supply to that area. Pain, swelling and difficulty weightbearing are most common when a child or teenager begins to walk. It is more common in females than in males.
CAUSES:
- Temporary interruption of the blood supply to the end of the bone which can be seen with low-grade micro trauma to the area. This can be seen in sports that require the young athlete to do repetitive movements on the ball of the foot.
- Trauma to the ball of the foot, as a child or teenager may jump from a height landing hard on the ball of the foot, causing injury to the blood supply to that area.
- Structural abnormalities are common in which the second metatarsal is much longer than the other metatarsals.
- Metabolic disorders must be ruled out.
SYMPTOMS:
- Pain, tenderness and swelling are present on the top and bottom of the foot usually behind the second toe. It may also uncommonly occur in the third or fourth metatarsal head as well.
- Pain with movement of the second, third or fourth toes in a flexed or extended posture.
- Avoidance of all weight on the ball of the foot is seen as the child walks on the heel or the outside of the foot to avoid pressure to the affected area.
X-RAYS:
- May be normal at first in the earlier stages. With time can progress to flattening of the metatarsal head as it loses its normal rounded appearance. Fragmentation and arthritis in the joint may be a late development.
TREATMENT:
- It is important to identify the injury at its earliest stage to prevent the head of the bone from collapsing which can cause arthritis in the second toe joint.
- Immobilization in a boot that extends beyond the toes coupled with the use of crutches will help to take pressure off the area and allow the blood supply to improve to the bone and healing to take place. Immobilization may be necessary for 6-12 weeks.
- Following immobilization when weightbearing is pain free, the child or teenager is transferred into an orthotic in their shoe to avoid pressure to the metatarsal affected.
- Avoidance of activity on the ball of the foot for a period of months will allow uneventful healing if bony changes have not taken place.
- If collapse of the bone is seen, surgery may be necessary to remove damaged cartilage and decompress the joint to take stress off the area.
- If seen early, this condition should cause no long-term problems.
- If seen late, osteoarthritis and pain may be a long-term consequence.
Below is an example of Freiberg' infarction of the second metatarsal head.
