Can affect any metatarsal head, but 2nd is most common (70%). Usually ages 11-17. F>M.
Due to collapse of articular cartilage.
Painful on walking, tender to palpation (usually more on dorsum), ROM is limited with pain at extremes of motion, may have crepitus, may have swelling.
On x-ray get a flattening of head of metatarsal or an ‘egg crush’ appearance. In adults higher chance of developing degenerative joint disease.
Stage 1 – subchondral bone fracture through epiphysis – x-rays normal.
Stage 2 – bone resorption as revascularisation begins
Stage 3 – medial and lateral portion of metatarsal head protrude
Stage 4 – central fragment “sinks”
Stage 5 – joint destruction
Treatment – activity modification/limitation; accommodative padding to relieve weightbearing or metatarsal bar for ‘roll over’. Below knee casting can be used. Surgical – excision of fragments; metatarsal head removal; wedge osteotomy to change parts of joint surface in contact; or joint implant.
Freiberg’s disease (Podiatry Arena)
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