Can affect any metatarsal head, but 2nd is most common (70%). Usually ages 11-17. F>M.
Due to collapse of articular cartilage.
Aetiology:
Not clear.
Probably repeated microtrauma and overuse.
Perhaps increased risk with increased sports activity; use of higher heel shoes; longer second metatarsal; elevated first ray.
Impaired vascularity: maybe issue with absent 2nd dorsal metatarsal artery
Systemic disorders: increased incidence in Systemic Lupus Erythematosus
Clinical Features:
Painful on walking, tender to palpation (usually more on dorsum) at base of toe, 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.
Smillie’s (1957) classification:
Stage 1 – subchondral bone fracture through epiphysis – x-rays normal; visible on MRI.
Stage 2 – bone resorption as revascularisation begins; seen as dorsal collapse of articular surface on x-ray
Stage 3 – medial and lateral portion of metatarsal head protrude
Stage 4 – central fragment “sinks”; joint space narrowing
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.
http://radiopaedia.org/articles/freiberg-disease
External Links:
Freiberg’s disease (Podiatry Arena)
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