Summary about Disease
Freiberg's disease, also known as Freiberg's infraction, is a relatively uncommon condition that primarily affects the metatarsal bones in the foot, most commonly the second metatarsal head. It is a type of avascular necrosis, meaning that the bone tissue dies due to a lack of blood supply. This can lead to pain, stiffness, and eventually, collapse of the metatarsal head. It's more common in adolescent girls, especially those undergoing rapid growth spurts.
Symptoms
Pain in the forefoot, specifically around the affected metatarsal head.
Stiffness in the affected toe.
Swelling and tenderness around the affected metatarsal head.
Limited range of motion in the affected toe.
Pain that worsens with activity and improves with rest.
Limping.
Development of a callus under the affected metatarsal head.
Causes
The exact cause is not fully understood, but several factors are believed to contribute:
Repetitive stress: Activities involving repetitive impact to the forefoot, such as dancing or high-impact sports.
Vascular compromise: Interruption of blood flow to the metatarsal head, leading to avascular necrosis.
Anatomical factors: A long second metatarsal bone puts more stress on the metatarsal head.
Trauma: A single injury, such as a fracture, may occasionally contribute.
Endocrine factors Rapid bone growth combined with hormonal factors.
Medicine Used
Pain relievers: Over-the-counter pain relievers like ibuprofen (Advil, Motrin) or naproxen (Aleve) to reduce pain and inflammation.
Corticosteroid injections: In some cases, a doctor may inject corticosteroids into the affected area to reduce inflammation and pain. This is not a long-term solution.
Bisphosphonates: Sometimes used to try and improve bone density, but effectiveness for Freiberg's disease is still being researched.
Is Communicable
No, Freiberg's disease is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Activity modification: Reduce or avoid activities that aggravate the pain.
Proper footwear: Wear supportive shoes with good arch support and a wide toe box. Avoid high heels or shoes that put excessive pressure on the forefoot.
Orthotics: Use metatarsal pads or custom orthotics to redistribute weight and relieve pressure on the affected metatarsal head.
Weight management: Maintaining a healthy weight can reduce stress on the feet.
Rest: Allow the foot to rest and recover after activity.
How long does an outbreak last?
The duration of symptoms can vary significantly depending on the severity of the condition and the individual's response to treatment. Without treatment or modification of activities, symptoms can persist for months or even years. With conservative management, symptoms may improve within several weeks to months. If surgery is required, recovery can take several months. There isn't a specific "outbreak" as such, it is a condition that develops gradually.
How is it diagnosed?
Physical examination: A doctor will examine the foot to assess pain, swelling, and range of motion.
X-rays: X-rays are the primary diagnostic tool. They can show changes in the shape of the metatarsal head, such as flattening, fragmentation, or collapse.
MRI (Magnetic Resonance Imaging): An MRI may be used to detect early changes in the bone, such as bone marrow edema, before they are visible on X-rays. It can also help rule out other conditions.
Bone scan: Bone scans are less commonly used but can help assess the blood supply to the bone.
Timeline of Symptoms
The timeline of symptoms can vary, but generally follows this pattern:
Early stage: Mild pain and stiffness in the forefoot, often after activity.
Intermediate stage: Pain becomes more persistent and noticeable, even at rest. Swelling and tenderness develop around the affected metatarsal head. Range of motion in the toe becomes limited.
Late stage: Significant pain, stiffness, and swelling. Deformity of the metatarsal head may be visible. Limping is common. Development of arthritis in the joint.
Important Considerations
Early diagnosis and treatment are crucial to prevent further damage and improve outcomes.
Conservative management (activity modification, orthotics, pain relievers) is often effective in the early stages.
Surgery may be necessary in severe cases or when conservative treatment fails. Surgical options include core decompression, osteotomy, or joint resurfacing/replacement.
Long-term follow-up is important to monitor the condition and prevent recurrence.
Differential diagnosis: Other conditions that can cause similar symptoms, such as stress fractures, Morton's neuroma, and metatarsalgia, need to be ruled out.