Freiberg's Disease Research Articles

Unilateral sequential Freiberg's disease: An atypical presentation

Freiberg's disease is a relatively rare disorder specific to the lesser metatarsal heads, most commonly affecting the second metatarsal. Despite the many anatomical variations described in the literature, the disease commonly affects a solitary metatarsal. We describe a rare case of unilateral involvement of three metatarsal heads in a child.

A case report; Freiberg's disease that operates with osteochondral graft

A case report; Freiberg's disease that operates with osteochondral graft

Freiberg’s Infraction in Identical Twins: A Case Report

Freiberg's infraction is an ostechondrosis of a lesser metatarsal head resulting in degeneration of the metatarsophalangeal joint. Several mechanisms have been suggested in its pathenogenesis. Freiberg first described the entity and believed single impact trauma was the underlying cause. Repetitive biomechanical microtrauma is the most widely accepted etiologic theory. Other factors contributing to its development include aseptic necrosis, ischemia, and a congenital predisposition. We present a case report of Freiberg's infraction occurring in identical twins involving multiple metatarsals in various stages of degeneration. One of the twins was affected unilaterally whereas the other twin was affected bilaterally. Both twins had involvement of the second metatarsal on the same side extremity. The occurrence of Freiberg's infraction in identical twins suggests that an underlying congenital predisposition to the condition may play more of a role than previously considered.

Severe Bilateral Foot Pain In A High School Football Player

HISTORY We present a high school football player with bilateral forefoot pain. During the first week of the season, he trained once a day without pain. There was no acute injury. He then began practicing three times a day and developed gradually worsening bilateral foot pain. The pain was initially present only with activity. However, after one week of the intense training schedule, it became constant. PHYSICAL EXAMINATION The patient was a well-built football player (200 lbs. 6 ft. 3 in.) with bilateral limping. He had normal hip and leg strength and range of motion. The arches were also normal. His feet had no swelling, edema, ecchymosis, or deformities. His right forefoot was diffusely tender to palpation and the pain was greatest along the first and third metatarsals. His left forefoot was also diffusely tender to palpation, with the greatest pain along the second metatarsal shaft. DIFFERENTIAL DIAGNOSIS Metatarsal fractures, metatarsalgia, Freiberg's infraction, myofascial strain of the interossei, sprain of the transverse ligament, extensor digitorum tendonitis, Lis Franc Ligament sprain, Morton's neuromas, or metatarsal stress fractures. TEST AND RESULTS To distinguish between the above etiologies of foot pain, MRI of the feet was performed. T2 weighted images demonstrated significantly increased signal within the shafts of the right first and third metatarsals, as well as the left second metatarsal. The remainder of the metatarsals also showed mild T2 signal abnormality. There were no fracture lines seen on either T1 or T2 images. FINAL WORKING DIAGNOSIS Grade II stress fractures of the right first and third metatarsals and left second metatarsal with diffuse stress reaction throughout both feet. TREATMENT AND OUTCOMES The patient was held from athletic participation and was weight bearing as tolerated for 3 weeks, but had little improvement. He was then given crutches for 2 weeks and his symptoms improved significantly. Dietary counseling was provided and he was educated on proper footwear and training regimens. Gait analysis is planned after the symptoms are fully resolved.

Freiberg's disease in old man

Freiberg's disease in old man

Persistent Metatarsalgia Caused by Freiberg's Disease

Objectives: To enhance the awareness and hence early diagnosis of Freiberg's disease in sportspersons complaining of metatarsalgia. Methods: A case report is presented wherein the correct diagnosis was made late in the natural pathogenesis of the disorder. Results: Salvage surgery was carried out but prevention and preservation of the anatomy would be preferred. Conclusions: Although the exact etiology of Freiberg's disease remains uncertain, early diagnosis and appropriate treatment is desirable rather than a salvage procedure.

Elongation osteotomy for intractable transfer metatarsalgia after metatarsal head excision for Freiberg's disease

Metatarsalgia after excision of the metatarsal head for Freiberg's infarction remains an unresolved problem. We carried out an elongation osteotomy of the metatarsal shaft in two patients, who developed metatarsalgia after excision of the metatarsal head for Freiberg's infarction. At 4 years follow-up there was good symptomatic relief.

A new surgical technique for treating bilateral freiberg disease

Freiberg disease is relatively rare and difficult to treat satisfactorily. We describe a new surgical technique of osteochondral plug transplantation for late-stage Freiberg disease that may restore normal function to the metatarsophalangeal joint. In the present series, we performed osteochondral plug transplantation to treat a stage IV lesion, according to Smillie’s classification, by harvesting an osteochondral plug from the non-weight-bearing site on the upper lateral femoral condyle of the ipsilateral knee. We also treated a stage II lesion using retrograde drilling. One year after surgery, the patient had no pain when running and returned to full athletic activity. The clinical and morphologic results were excellent. Arthroscopic intervention produced good results in the early stages and osteochondral plug transplantation may be an excellent surgical procedure to restore normal function to the metatarsophalangeal joint in the later stages of Freiberg disease.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 6 (July-August), 2002: pp 660–664

Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging.

Many disorders produce discomfort in the metatarsal region of the forefoot. These disorders include traumatic lesions of the soft tissues and bones (eg, turf toe, plantar plate disruption, sesamoiditis, stress fracture, stress response), Freiberg infraction, infection, arthritis, tendon disorders (eg, tendinosis, tenosynovitis, tendon rupture), nonneoplastic soft-tissue masses (eg, ganglia, bursitis, granuloma, Morton neuroma), and, less frequently, soft-tissue and bone neoplasms. Prior to the advent of magnetic resonance (MR) imaging, many of these disorders were not diagnosed noninvasively, and radiologic involvement in the evaluation of affected patients was limited. However, MR imaging has proved useful in detecting the numerous soft-tissue and early bone and joint processes that occur in this portion of the foot but are not depicted or as well characterized with other imaging modalities. Frequently, MR imaging allows a specific diagnosis based on the location, signal intensity characteristics, and morphologic features of the abnormality. Consequently, MR imaging is increasingly being used to evaluate patients with forefoot complaints. Radiologists should be familiar with the differential diagnosis and MR imaging features of disorders that can produce discomfort in this region.

Surgery for symptomatic Freiberg's disease: extraarticular dorsal closing-wedge osteotomy in 13 patients followed for 2-4 years.

From 1992 through 1995, we have treated 13 patients (10 men) with Freiberg's disease by debridement and dorsal closing-wedge osteotomy of the metatarsal neck. The lesion was located in the second metatarsal head in 10 patients and in the third metatarsal head in 3. After osteotomy, the lesion was away from the joint, so that the smooth and healthy articular cartilage of the metatarsal head faced the phalangeal cartilage. The average follow-up period was 40 (28-54) months. The subjective outcome was good or excellent in 11 patients, fair in 1, and poor in 1. We found MRI useful in determining the extent of the lesion when planning correction.

Acute Freiberg's disease in adjacent metatarsals

We report the first case of active Freiberg's disease in adjacent rays. The presentation was initially difficult to distinguish from forefoot cellulitis, however, magnetic resonance imaging was helpful in establishing the diagnosis and identifying the affected rays.

Freiberg's infraction: A new surgical procedure

An interpositional arthroplasty is described as a long-lasting solution for Freiberg's infraction of the metatarsal head. The tendon of the extensor digitorum longus is used for adequate surfacing and as a spacer. The deformed head is remodelled down to healthy bone with bevelling of its volar aspect to provide a smooth weightbearing surface covered by tendon tissue cushion. The results, analyzed on clinical and subjective bases, show evident relief of pain and improvement in activity level. The passive range of motion at the metatarsophalangeal joint (especially dorsiflexion) did not improve compared to its preoperative values, yet its quality was better (nonpainful in 85%). Radiographic study revealed a maintained metatarsophalangeal space after 11 to 27 months of follow-up. Of the 13 patients studies, 10 (77%) described the final outcome as excellent; 1 (7.7%), as good; and 2 (15.3%), as fair.

Treatment of Freiberg's Disease with Joint Debridement and Reshaping of Metatarsal Head

Treatment of Freiberg's Disease with Joint Debridement and Reshaping of Metatarsal Head

FOREFOOT SURGERY. Edited by B. Valtin and under the care of Groupe dʼÉtude du Pied (GEP). Paris, Expansion Scientifique Française, 1997. $110.00, 165 pp.

This concise text includes contributions from fourteen authors, all of whom are members of the French Orthopaedic Association and have a special interest in the foot and ankle. There are chapters on anatomy, biomechanics, hallux valgus (operative treatment only), metatarsalgia, hallux rigidus, failed treatment of bunions, the lesser toes, Morton disease, Freiberg disease, the rheumatoid forefoot, tarsal tunnel syndrome (because of its symptomatology extending to the forefoot), medicolegal considerations, and orthoses. With few exceptions, such as the use of PID (as opposed to DIP) for the distal interphalangeal joint, the style of writing and the translation are so close to the commonly used English language of orthopaedic literature that the level of comprehension is essentially equivalent. The illustrations are excellent. One of the main thrusts of the book—and perhaps also the most noteworthy feature for the American reader—is the emphasis on the Scarf procedure and the Weil osteotomy, which are rarely used in the United States. An unpublished survey of thirty-two prominent orthopaedic …

Freiberg's disease following fracture of the second metatarsal bone

We report a case of Freiberg's disease of the second metatarsal head in an 18-year-old man, diagnosed 1 year after fracture of the second to fourth metatarsals. A definite history of minor foot trauma is not uncommon in Freiberg's disease but we believe this to be the first reported case consequent to major fracture of the affected metatarsal.

Sequential unilateral Freiberg's disease

We report the first case of unilateral sequential Freiberg's disease in an adolescent girl with no predisposing factors.

Dorsal Closing Wedge Osteotomy in Freiberg's Disease

Dorsal Closing Wedge Osteotomy in Freiberg's Disease

Freiberg's infraction: a case from medieval Kent

A. M. Freiberg described a condition in which a collapse of the juvenile second metatarsal head gave rise to localized pain and swelling. 1 This eponymous disease is traditionally classed as one of the osteochondroses: a group of disparate lesions which typically manifest as destruction of an immature epiphysis. A medieval second metatarsal is presented, which by osteological and radiological examination is diagnostic of Freiberg's infraction. Apparently, this is the first evidence that the condition is not confined to modern day populations. 2

Freiberg's disease present in adjacent metatarsals

Freiberg's disease, often described as a form of osteochondritis juvenalis, usually affects the second and occasionally the third metatarsal heads. It is most common in adolescent females and is associated with secondary degenerative change. The case presented is a 60-year-old female who developed Freiberg's disease in both the second and third metatarsal heads of the same foot. Whilst the coexistence of this disease in more than one metatarsal has been previously suggested 1, the authors have found no other example of this. Suggestions have been made that the second metatarsal is vulnerable to this condition because of its relatively longer length, although the explanation behind this has not been made clear. Recently, however, authors have postulated a multifactorial aetiology 2 incorporating relative metatarsal length as part of the explanation. The occurrence of the disease in adjacent metatarsal bones of different length, provides further support to a multifactorial aetiology.

Disorders of the Lesser Metatarsophalangeal Joints.

Pain in the region of the lesser metatarsophalangeal joints (often termed metatarsalgia) is a common complaint. It can be due to a variety of causes, and accurate diagnosis is essential for effective treatment. Understanding the anatomy and functions of the extrinsic and intrinsic musculature and the plantar plate, ligaments, and fat pad is important in evaluating metatarsophalangeal joint disorders. Claw toe is a hyperextension deformity of the metatarsophalangeal joint in combination with a hammer toe. Pathologic changes involving an isolated metatarsophalangeal joint may be due to monarticular synovitis. Systemic inflammatory disorders can cause variable degrees of instability, resulting in sub-luxation or dislocation. Other specific disorders at the lesser metatarsophalangeal joints include discrete and diffuse intractable plantar keratoses, Freiberg's infraction, and cock-up fifth toe. Once the specific pathologic entity has been determined, the appropriate course of nonsurgical or, if necessary, operative treatment can be instituted.