This article has multiple issues. Please help improve it or discuss these issues on the talk page . (Learn how and when to remove these messages)
|
Freiberg disease, also known as a Freiberg infraction, is a form of avascular necrosis in the metatarsal bone of the foot. It generally develops in the second metatarsal, but can occur in any metatarsal. Physical stress causes multiple tiny fractures where the middle of the metatarsal meets the growth plate. These fractures impair blood flow to the end of the metatarsal resulting in the death of bone cells (osteonecrosis). It is an uncommon condition, occurring most often in young women, athletes, and those with abnormally long metatarsals. Approximately 80% of those diagnosed are women. [1]
Initial treatment is generally 4–6 weeks of limited activity, often with crutches or orthotics. In rare cases, surgery is necessary to reduce the bone mass of the metatarsal.
The condition was first described by Alfred H. Freiberg in 1914. He initially thought the condition was caused by acute physical trauma, which is why it was initially called an infraction. [1] [2] [3] [4]
Freiberg disease | |
---|---|
Other names | Freiberg infraction |
Freiberg disease as seen on plain film | |
Specialty | Orthopedics |
Freiberg disease is a rare condition that affects the second metatarsal head, leading to pain and potential deformity. It is often associated with activities that place stress on the forefoot, such as running or jumping. The disease was first described by the German surgeon Paul Freiberg in 1914. Its prevalence is not well-documented, but it is believed to be more common in females than males. [1]
Patients with Freiberg disease typically present with a range of signs and symptoms that can vary in severity and progression:
Symptom | Description |
---|---|
Pain | Localized pain in the forefoot, particularly during weight-bearing activities. The pain is often described as sharp or aching and may worsen with prolonged standing or walking. |
Swelling | Edema around the affected metatarsal head, which can be visible and palpable. The swelling may fluctuate but is generally persistent. |
Stiffness | Reduced range of motion in the metatarsophalangeal joint, leading to difficulty in flexing or extending the affected toe. |
Limping | Altered gait to avoid pain during walking, often characterized by a tendency to bear weight on the lateral aspect of the foot. |
Callus formation | Thickening of the skin beneath the affected metatarsal head, which can develop as a result of altered weight-bearing patterns. |
In addition to these primary symptoms, patients may experience:
The severity of symptoms can vary widely among individuals and may progress over time if left untreated.
While the exact etiology of Freiberg disease remains unclear, several factors have been identified as potential contributors:
Understanding these contributing factors is crucial for both prevention and management of Freiberg disease, as it allows for targeted interventions and lifestyle modifications. [5]
The pathophysiology of Freiberg disease involves a complex interplay of vascular, mechanical, and traumatic factors. The process typically begins with a disruption of blood supply to the metatarsal head, leading to avascular necrosis of the bone tissue. As the affected bone loses its structural integrity, it begins to collapse under weight-bearing stress. This collapse is often progressive and can lead to significant deformity of the metatarsal head.Concurrent with bone changes, the articular cartilage covering the metatarsal head deteriorates, resulting in joint surface irregularities. These changes can further exacerbate pain and limit joint function. The body's attempt to repair the damaged area leads to an inflammatory response, which contributes to ongoing tissue damage and may play a role in the chronic nature of the condition. Several theories attempt to explain the underlying mechanisms of Freiberg disease:
Recent research has also explored the potential role of genetic factors and hormonal influences in the development of Freiberg disease, suggesting a multifactorial etiology. [5]
Accurate diagnosis of Freiberg disease typically involves a combination of clinical examination and imaging studies:
Differential diagnosis is important, as several conditions can mimic Freiberg disease, including stress fractures of the metatarsal, Morton's neuroma, and various forms of arthritis.
Treatment for Freiberg disease varies depending on the stage of the disease and the severity of symptoms. Options include:
Nonoperative Management
Freiberg disease is relatively rare, but it is more commonly diagnosed in young females, particularly those involved in sports or activities that place repetitive stress on the forefoot. The condition typically presents during adolescence or early adulthood, with a peak incidence in individuals aged 10 to 20 years. While the exact prevalence is not well-documented, it is recognized as a significant cause of forefoot pain in this demographic.
The prognosis for Freiberg disease varies depending on the stage at diagnosis and the chosen treatment approach. Early diagnosis and appropriate management can lead to favorable outcomes, with many patients experiencing significant pain relief and improved function. However, some individuals may develop chronic pain or limitations in physical activities, particularly if the condition is left untreated or progresses to advanced stages.
Recent studies have focused on improving our understanding and management of Freiberg disease:
A bunion, also known as hallux valgus, is a deformity of the MTP joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. The onset of bunions is typically gradual. Complications may include bursitis or arthritis.
Legg–Calvé–Perthes disease (LCPD) is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. Due to the lack of blood flow, the bone dies and stops growing. Over time, healing occurs by new blood vessels infiltrating the dead bone and removing the necrotic bone which leads to a loss of bone mass and a weakening of the femoral head.
Pes cavus, also known as high arch, is an orthopedic condition that presents as a hollow arch underneath the foot with a pronounced high ridge at the top when weight bearing.
Flat feet, also called pes planus or fallen arches, is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. Sometimes children are born with flat feet (congenital). There is a functional relationship between the structure of the arch of the foot and the biomechanics of the lower leg. The arch provides an elastic, springy connection between the forefoot and the hind foot so that a majority of the forces incurred during weight bearing on the foot can be dissipated before the force reaches the long bones of the leg and thigh.
A shin splint, also known as medial tibial stress syndrome, is pain along the inside edge of the shinbone (tibia) due to inflammation of tissue in the area. Generally this is between the middle of the lower leg and the ankle. The pain may be dull or sharp, and is generally brought on by high-impact exercise that overloads the tibia. It generally resolves during periods of rest. Complications may include stress fractures.
Osgood–Schlatter disease (OSD) is inflammation of the patellar ligament at the tibial tuberosity (apophysitis) usually affecting adolescents during growth spurts. It is characterized by a painful bump just below the knee that is worse with activity and better with rest. Episodes of pain typically last a few weeks to months. One or both knees may be affected and flares may recur.
A Jones fracture is a broken bone in a specific part of the fifth metatarsal of the foot between the base and middle part that is known for its high rate of delayed healing or nonunion. It results in pain near the midportion of the foot on the outside. There may also be bruising and difficulty walking. Onset is generally sudden.
Neuropathic arthropathy refers to a progressive fragmentation of bones and joints in the presence of neuropathy. It can occur in any joint where denervation is present, although it most frequently presents in the foot and ankle. It follows an episodic pattern of early inflammation followed by periarticular destruction, bony coalescence, and finally bony remodeling. This can lead to considerable deformity and morbidity, including limb instability, ulceration, infection, and amputation.
Osteochondrosis is a family of orthopedic diseases of the joint that occur in children, adolescents and rapidly growing animals, particularly pigs, horses, dogs, and broiler chickens. They are characterized by interruption of the blood supply of a bone, in particular to the epiphysis, followed by localized bony necrosis, and later, regrowth of the bone. This disorder is defined as a focal disturbance of endochondral ossification and is regarded as having a multifactorial cause, so no one thing accounts for all aspects of this disease.
Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces, which results in the entrapment of the affected nerve. The main symptoms are pain and/or numbness, sometimes relieved by ceasing to wear footwear with tight toe boxes and high heels. The condition is named after Thomas George Morton, though it was first correctly described by a chiropodist named Durlacher.
Spondylolysis is a defect or stress fracture in the pars interarticularis of the vertebral arch. The vast majority of cases occur in the lower lumbar vertebrae (L5), but spondylolysis may also occur in the cervical vertebrae.
Madelung's deformity is usually characterized by malformed wrists and wrist bones and is often associated with Léri-Weill dyschondrosteosis. It can be bilateral or just in the one wrist. It has only been recognized within the past hundred years. Named after Otto Wilhelm Madelung (1846–1926), a German surgeon, who described it in detail, it was noted by others. Guillaume Dupuytren mentioned it in 1834, Auguste Nélaton in 1847, and Joseph-François Malgaigne in 1855.
Greater trochanteric pain syndrome (GTPS), a form of bursitis, is inflammation of the trochanteric bursa, a part of the hip.
Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of college, followed by 4 years of medical school or osteopathic medical school to obtain an M.D. or D.O. followed by specialist training as a resident in orthopaedics, and only then do they sub-specialise in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school (D.P.M.), 3–4 years of a surgical residency and an optional 1 year fellowship.
March fracture is the fracture of the distal third of one of the metatarsal bones occurring because of recurrent stress. It is more common in soldiers, but also occurs in hikers, organists, and other people whose duties entail much standing. March fractures most commonly occur in the second and third metatarsal bones of the foot. It is a common cause of foot pain, especially when people suddenly increase their activities.
Pigeon toe, also known as in-toeing, is a condition which causes the toes to point inward when walking. It is most common in infants and children under two years of age and, when not the result of simple muscle weakness, normally arises from underlying conditions, such as a twisted shin bone or an excessive anteversion resulting in the twisting of the thigh bone when the front part of a person's foot is turned in.
Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.
Trapeziometacarpal osteoarthritis (TMC OA) is, also known as osteoarthritis at the base of the thumb, thumb carpometacarpal osteoarthritis, basilar (or basal) joint arthritis, or as rhizarthrosis. This joint is formed by the trapezium bone of the wrist and the metacarpal bone of the thumb. This is one of the joints where most humans develop osteoarthritis with age. Osteoarthritis is age-related loss of the smooth surface of the bone where it moves against another bone (cartilage of the joint). In reaction to the loss of cartilage, the bones thicken at the joint surface, resulting in subchondral sclerosis. Also, bony outgrowths, called osteophytes (also known as “bone spurs”), are formed at the joint margins.
Syndesmosis procedure is one of the more than twenty bunion surgeries currently being performed. While the majority of bunion surgeries involve the breaking and shifting of bones, syndesmosis procedure is one of few surgical techniques that use a soft-tissue or non-osteotomy (non-bone-breaking) approach to afford the same correction. More than 130 different surgical techniques have been described for correction of one single condition of the foot: the bunion deformity.
Posterior tibial tendon dysfunction is the dysfunction of the posterior tibial tendon. It is a progressive disease that has four stages and is the most common cause of adult flatfoot.
{{cite web}}
: CS1 maint: multiple names: authors list (link)