Freiberg’s disease refers to a painful condition mostly affecting the 2nd metatarsal head. This is the bony ‘knuckle’ in the ball of the foot behind the 2nd toe. The term is also used when the 3rd or 4th metatarsal bones are affected, though these are much less common. Over 80% of cases affect females and most commonly occur in young women up to around 20 years of age. It is likely that Freiberg’s disease, when it occurs in children, is due to a disruption of blood flow to the tip of the bone occurring because of excessive pressure. This happens at the site of the growth plate which closes over in adolescence and therefore is not a factor in the adult sufferers. In both cases, the mechanical cause is thought to be the same. This may be a single traumatic event such as a heavy blow, or a multitude of small insults that accumulate in a ‘straw that broke the camel’s back’ manner.
The term infarct means tissue death because of lack of blood. Freiberg’s Infarction is the term applied to the condition when it occurs in a child. It is likely that the excessive pressure causes a small fracture to occur within the cartilage growth plate that exists between the long shaft of the metatarsal bone and the head, cutting off the blood flow. On x-ray, the area will be more transparent as calcium leaves the bone which will soon collapse in on itself. The process of death and regeneration takes about a year to run through and the bone will be denser and whiter when complete. A classic x-ray sign is a flattening of the usually rounded tip of the metatarsal bone and a thickening of the shaft.
Freiberg’s Infraction is the terminology used in the adult condition where the x-ray signs are very similar. It has been shown that, while many people have two or three arteries that can supply blood to the area, some have only one making complete loss of blood flow more possible. Another factor that is very common is sufferers is a 1st metatarsal that does not function properly and shunts its share of the body weight over to the 2nd, 3rd and 4th bones. Podiatrists term this 1st Ray Incompetence.
Treatment of Freiberg’s Disease.
Examination of the foot in both conditions will show the area to be swollen, stiff and painful. To find the most tender spot, the podiatrist will flex the little toes back as far as possible to expose the end of the metatarsals as well as the bottom surface of them. Treatment: Referral to a podiatrist is always strongly recommended when Freiberg’s disease is suspected. Treatment will focus on reducing the pressure on the 2nd metatarsal head, either by deflecting pressure away from this area, causing the 1st metatarsal to do its share of the weight bearing or a combination of both.
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