Freiberg’s Disease

What is Freiberg's Disease?

Freiberg’s Disease is a condition that typically affects the second metatarsal of the foot, specifically the metatarsal head, but can also involve other metatarsals (rarely). It is a form of osteochondritis, where there is avascular necrosis (death of bone tissue due to lack of blood supply) that leads to deterioration and collapse of the metatarsal head. This condition can cause significant pain and difficulty in foot movement.

Causes of Freiberg's Disease

The exact cause of Freiberg's Disease is not completely understood, but several factors can contribute to its development, including:

Repetitive Trauma: Activities involving repetitive pressure on the second metatarsal head, such as sports requiring high impact or rapid direction changes, can contribute to the condition.
Foot Biomechanics: Changes in foot mechanics, such as a high arch or weight distribution anomalies, can exert additional stress on the metatarsal head.
Inadequate Footwear: Use of footwear that doesn't offer adequate support or exerts excessive pressure on the midfoot can increase risk of disease development.
Genetic Predisposition: Although less understood, there may be a genetic predisposition to Freiberg's Disease.

Symptoms of Freiberg's Disease

Symptoms of Freiberg's Disease may include:

Foot Pain: Localized pain in the second metatarsal head, often aggravated by physical activity and relieved by rest.
Swelling: Increased volume and fluid accumulation around the affected area.
Stiffness: Difficulty moving the foot or performing activities involving foot flexion and extension.
Gait Changes: Modifications in walking pattern to avoid pain, which can lead to other foot and leg problems.
Tired Sensation: Feeling of fatigue when bearing weight or walking, due to pain and altered foot mechanics.

Diagnosis of Freiberg's Disease

To diagnose Freiberg's Disease, doctors use:

Physical Examination: Assessment of pain, swelling, and changes in foot structure. The doctor may perform specific tests to identify exact pain area and evaluate foot function.
Imaging Tests: X-rays are used to visualize bone changes and confirm diagnosis. In some cases, computed tomography (CT) or magnetic resonance imaging (MRI) may be necessary to obtain a more detailed view of bone structure and soft tissues.

Treatment of Freiberg's Disease

Treatment of Freiberg's Disease aims to relieve symptoms and improve foot function. Options include:

Conservative Treatment: Includes rest, ice application, use of orthopedic insoles to reduce pressure on the metatarsal, and physical therapy to strengthen muscles around the foot and improve mobility.
Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to control pain and inflammation associated with the condition.
Activity Modification: Reducing or avoiding activities that cause pain and additional stress on the foot can help relieve symptoms.
Surgery: In severe cases, when conservative treatments are not effective, surgery may be necessary. Surgical procedures may include correction of deformity, removal of bone fragments, or reconstruction of the metatarsal joint.

Prevention of Freiberg's Disease

Although it's not possible to completely prevent Freiberg's Disease, some measures can help reduce risk and disease progression:

Use of Appropriate Footwear: Footwear that offers adequate support and cushioning can help protect the metatarsal head.
Muscle Strengthening: Exercises to strengthen leg and foot muscles can improve stability and foot biomechanics.
Weight Care: Maintaining a healthy weight can reduce load on the foot and help prevent condition worsening.

Conclusion

Freiberg’s Disease is a condition that can cause significant pain and affect foot function. Identifying symptoms early and seeking appropriate medical evaluation are fundamental steps for effective treatment and better quality of life. With the appropriate approach and preventive measures, many patients can control symptoms and maintain an active and functional life.