Freiberg’s disease is a condition that typically affects the second metatarsal head in your foot. The issue develops when the metatarsal head loses its structural integrity, which can lead to collapse of the joint surface and pain in your second metatarsophalangeal joint (MTP). Today, we take a closer look at this condition, why it occurs, and what can be done to treat it.
Causes and Symptoms of Freiberg’s Disease
Not much is known about the cause of Freiberg’s disease, but medical experts believe that vascular issues are at play. Essentially, blood supply to a part of the bone of the metatarsal head gets reduced or cut off for one reason or another. This leads to a loss in MTP joint stability or a collapse at the joint.
Symptoms of the condition include:
- Pain in the front of the foot
- Stiffness in the front of the foot
- Inhibited gait or a limp
- The sensation you’re walking on something hard
- Increased pain with weight-bearing exercise
- Swelling around the MTP joint
- Sometimes a callus will form underneath the metatarsal head
Diagnosis and Treatment
Diagnosing the condition is a little tricky in its earliest stages, because there are typically no radiographic changes at this point. A doctor will look for joint space widening, and in more progressed cases, a flattening of the metatarsal head with or without increased radiodensity of the metatarsal head. Advanced cases show an arthritic joint, bone spur formation or other loose bodies in the joint.
Treatment depends on how advanced the condition is when intervention starts. For patients in an early stage of Freiberg’s disease, casting or weight-assisted walking boots can help to alleviate symptoms. Patients may also be advised to try stiff orthotic inserts, metatarsal pads or a rocker bottom shoe, and Achilles stretches can help to decrease forefoot loading and pain symptoms.
If the condition is too far along for conservative care to quell symptoms, more hands-on treatment may be necessary. For the right patient, a joint debridement can help by removing any loose bodies and bone spurs to help combat discomfort. Metatarsal osteotomies have sometimes been used to rotate the more normal plantar cartilage onto the end-loading surface of the metatarsal head. For extreme cases, metatarsal head excision with or without interposition arthroplasty is often the preferred surgical route.
For more information about Freiberg’s disease, or to talk to Dr. Silverman about your painful foot condition, reach out to him in the contact box below.