The use of surgical core decompression as treatment for avascular necrosis of the second and third metatarsal heads

Abstract

Freiberg's disease, a type of avascular necrosis, is an idiopathic osteochondrosis disorder affecting epiphyses of developing bones in children, particularly the second metatarsal with respect to the foot. This disorder can be caused by acute trauma and has been documented that exacerbation of it is present in patients with an elongated second metatarsal, thus, making it more vulnerable to repetitive trauma. Here we present a patient with a chief complaint of a painful mass. Radiographic and repetitive MRI findings were used to diagnose the patient with Freiberg's disease. Following the benefit time of conservative care, surgical core decompression was the surgical course of treatment. Core decompression has been routinely used to prevent structural changes in the metatarsal head and to relieve pain by decreasing the increased intraosseous pressure associated with avascular necrosis and allowing for revascularization of the necrotic area. The use of surgical core decompression with respect to the metatarsal head is relatively new; but has been routinely used for the hip and knee. Whether or not this form of surgical treatment will prevent recurrence is uncertain; further long-term studies are needed.