Freiberg's Disease is a painful condition that affects the second metatarsal head. This is the bony knuckle in the ball of the foot behind the second toe. It can also affect the third and fourth metatarsal bones, but they are less commonly affected.
More than 80% of cases are females, and most of those are women up to the age of 20 years. Children who are athletes are often most commonly affected, especially those who are on their toes a lot in sprinting or jumping. The primary complaint is often vague forefoot pain, worsened by activity and weight-bearing and relieved with rest.
Freiberg's Disease occurs in children when there is a disruption of blood flow to the tip of the bone because of excessive pressure. It happens at the site of the growth plate, which closes in adolescence and therefore does not affect adults. In some cases a mechanical cause is thought to be the reason for the condition. A traumatic event, such as a heavy blow, or several small incidents can also cause Freiberg's Disease.
Freiberg's Infarction is the term applied when it occurs to children. Infarct means tissue death because of lack of blood. It is likely the excessive pressure causes a small fracture to occur within the cartilage growth plate that is between the long shaft of the metatarsal bone and the head, cutting off the blood flow. On an x-ray the area will be transparent as calcium leaves the bone, which will collapse on itself. The process takes about a year and when it is complete, the bone will be denser and whiter. An x-ray will also show the flattening of the rounded tip of the metatarsal bone and thickening of the shaft.
Freigberg's Infraction is applied to adults where the x-rays are similar. Most people have two or three arteries supplying blood to the area, but some have only one artery, making possible bone death. In others, the first metatarsal does not function properly and shuns its share of the body weight over the second, third, and fourth bones.
Treatment includes examination of the foot, which should show the area to be swollen, stiff, and painful. To find the tender spot, the podiatrist will flex the toe back as far as possible to expose the end of the metatarsal as well as the bottom surface. Treatment will focus on reducing the pressure on the second metatarsal head, by deflecting the pressure away from the area, causing the first metatarsal to take its share of the weight.
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